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[Epilepsia partialis continua (Kojevnikov's syndrome)].
Karl O Nakken1, Ann-Sofie Eriksson, Hrisimir Kostov
1Spesialsykehuset for epilepsi, 1337 Sandvika. karl.otto.nakken@epilepsy.no
Summary
Epilepsia partialis continua (Kojevnikov's syndrome) involves prolonged focal motor seizures. Treatment challenges include disappointing antiepileptic drug responses and surgical risks, though some surgical options show promise.
Area of Science:
- Neurology
- Epileptology
Background:
- Epilepsia partialis continua (EPC), or Kojevnikov's syndrome, is characterized by focal motor seizures of long duration, often linked to lesions near the central sulcus.
- This study reviews 12 EPC cases treated at the National Centre for Epilepsy in Norway, examining occurrence, causes, clinical presentation, investigations, and treatment.
Observation:
- The study observed 12 patients with EPC, noting that 10 had identifiable morphological lesions.
- Lesions included cortical dysplasia, brain tumors, cerebral infarction, Rasmussen syndrome, and arteriovenous malformations causing cerebral hemorrhage.
Findings:
- Most patients (9/12) experienced intermittent jerking, while 3 had permanent jerks, with symptoms often localized to the face and/or hand.
- Antiepileptic drugs showed limited efficacy, with no patients becoming seizure-free.
- Surgery was performed on 5 patients; lesionectomy carried high risks, but multiple subpial transections and functional hemispherotomy (in one Rasmussen syndrome case) showed potential seizure-blocking effects.
Implications:
- EPC management presents significant challenges, with limited success from conventional antiepileptic drugs.
- Surgical interventions, while risky due to the proximity of lesions to eloquent cortex, offer potential therapeutic avenues.
- Further research into surgical techniques like multiple subpial transections and functional hemispherotomy is warranted for effective EPC treatment.