Epilepsia partialis continua (Kojewnikow's syndrome): report of one case

We describe a 12-year-old boy with EPC (Epilepsia Partialis Continua) who showed well localized myoclonic jerks in the left toes continuing for more than 19 months. Preceding partial clonic or tonic convulsions of the left leg or body were initially noted. Neurological examination disclosed mild muscle weakness of the left leg. During the course, neither mental deterioration nor progressive evolution was noted. Since the EEG revealed well defined midline central spike focus which represent the sensorimotor area of left leg and foot, we postulate that the pathophysiological mechanism of the EPC may be evoked by the focal epileptogenic activation of the motor cortex. EEG-EMG polygraphy proved the well localized myoclonic action potential volleys in the M. extensor hallucis longus of the left great toe. According to the clinical and electrophysiological findings, we classified our case into the group I of Bancaud's definition but failed to find out any demonstrable brain lesion throughout brain CT, MRI and angiography. Neurosurgical intervention is not practical for our case, and medical treatment gave somewhat improvement.