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Rolandic encephalopathy and epilepsia partialis continua following bone marrow transplant
N L Antunes1, F Boulad, V Prasad
1Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Insights
Epilepsia partialis continua (EPC), a prolonged focal myoclonus, can occur after bone marrow transplants. An unidentified infection may cause this rare encephalitis in immunosuppressed patients, responding to antiviral treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Epilepsia partialis continua (EPC) is characterized by persistent focal myoclonus, often treatment-resistant.
- EPC in children is commonly associated with Rasmussen encephalitis, a chronic encephalitis of unknown cause.
- Rasmussen encephalitis typically affects one hemisphere of the brain.
Observation:
- A child developed bilateral EPC five months post-bone marrow transplant.
- Neuroimaging revealed signal abnormalities in bilateral sensory-motor areas.
- The patient was immunosuppressed following the transplant.
Findings:
- Extensive etiological investigations were inconclusive.
- Treatment with a broad-spectrum antiviral agent led to the resolution of EPC.
- This suggests an infectious etiology previously unrecognized in this context.
Implications:
- An unidentified infectious agent might cause encephalitis affecting the motor cortex in immunosuppressed individuals.
- This case expands the known spectrum of post-transplant neurological complications.
- Further research is needed to identify the causative agent and understand its pathogenesis.
Abstract:
Epilepsia partialis continua (EPC) is a condition defined by prolonged focal myoclonus. Often resistant to therapy, EPC in children is frequently present in Rasmussen encephalitis, a form of chronic encephalitis of uncertain etiology. We discuss a child who developed bilateral EPC 5 months after a bone marrow transplant. Neuroimaging studies showed signal abnormalities on both sensory-motor areas. An extensive search failed to reveal the etiology of the disorder, but treatment with a broad-spectrum anti-viral agent was associated with resolution of the process. An unidentified infectious agent may be responsible for an encephalitis of the motor strip in immunosuppressed patients.