[Nonconvulsive status epilepticus of frontal origin. A case report]

Nonconvulsive status epilepticus (NCSE) of frontal origin is a form of partial status epilepticus which has rarely been well-documented. The inespecificity of the symptoms contribute frequently to its misinterpretation being the EEG the most useful tool to make an accurate diagnosis.

We report a 53-year-old woman who suffered from two generalized tonic-clonic seizures secondary to a left frontal hematoma in 1994. Onset of treatment with carbamazepine was followed by a complete control of seizures. After remaining seizure-free during four years, antiepileptic therapy was discontinued. By June 1999, she presented with a prolonged confusional state having a generalized tonic-clonic seizure at the emergency room. At that moment, a computed tomography (CT) scan was normal. Generalized seizures were controlled with phenytoin, however, the patient remained confused having occasionally episodes of turning of the head and eyes to the right side. Ictal EEG examination showed recurrent bilateral frontopolar, frontocentral and frontotemporal epileptiform discharges with a left frontal focal onset. The diagnosis of NCSE of frontal origin was made. Despite several anticonvulsant combinations, confusional state remained unchanged and she was transferred to the intensive care unit for sedation with propofol and mydazolam. On the following days, she experienced a marked improvement and EEG showed a few frontal spikes and sharp waves but without evidence of electrographic status epilepticus. The patient was finally discharged and remains seizure-free on phenytoin therapy.

Our clinical and EEG findings are in keeping with the diagnosis of NCSE of frontal origin. A severe confusional state was the most prominent symptom and EEG was essential for the diagnosis.