[Chlormethiazole in the treatment of complex partial epileptic status in childhood]

The authors report on the results of clinical investigations, treatment and follow-up of a 9-year old boy with complex partial status epilepticus (CPSE) which occurred after the first onset of partial secondary generalized epileptic seizures. Electroencephalografic recordings during status epilepticus showed a diffuse, generalized, high-voltage delta dysfunction and bilateral epileptiform activity, with local maximum over the posterior right temporal parietal regions. Parenteral administration of diazepam, phenytoin and phenobarbitone as choice anticonvulsant drugs, failed to stop CPSE in the patient. Only by continuous intravenous infusion of chlormethiazole (Heminevrin) status epilepticus was successfully controlled. Paroxysmal discharges on electroencephalogram disappeared and attenuation of slow wave activity was evident. Memory deficits and the elements of nominal dysphasia and tactile dysgnosia were apparent soon after cessation of CPSE and may be related to the signs of maximal local electroencephalographic dysfunction. Later testings after complete seizure control by chlormethiazole and phenytoin given orally, showed almost normal results. No side effects were encountered. A more common chlormethiazole administration as a useful therapeutic agent in the management of CPSE especially in children with refractory and long-time status, would be mandatory. Since chlormethiazole is free from serious side effects, its earlier use in the control of epileptic status may help to preclude some severe cognitive effects and to evade the use of barbiturate anesthesia as the last therapeutic resort.