Epilepsia partialis continua responsive to neocortical electrical stimulation.

Area of Science:

• Neurology
• Epileptology
• Neurosurgery

Background:

• Epilepsia partialis continua (EPC) is a rare form of focal status epilepticus characterized by continuous focal motor seizures, often affecting distal limbs.
• EPC typically originates from the motor cortex, making surgical resection challenging due to the risk of significant neurological deficits.

Observation:

• Two patients with drug-resistant EPC underwent intracranial video-electroencephalography monitoring to precisely locate the epileptogenic zone and map eloquent motor cortex.
• In both cases, the seizure focus was identified within or adjacent to critical motor areas, precluding standard resective surgical approaches.

Findings:

• Chronic cortical stimulation (60-130 Hz, 2-3 mA) applied via subdural strips to the seizure focus resulted in over 90% seizure reduction and abolition of EPC in both patients.
• Sustained seizure control was observed over a 22-month follow-up period, with seizure recurrence only upon reduction of stimulation intensity or battery depletion.
• Permanent implantation of cortical stimulators was well-tolerated, with no adverse effects reported.

Implications:

• Chronic cortical stimulation presents a promising, minimally invasive therapeutic option for drug-resistant epilepsia partialis continua originating from eloquent cortex.
• This approach may offer a viable alternative to resective surgery, preserving neurological function in patients with debilitating focal status epilepticus.
• Further research into neuromodulation techniques is warranted for managing rare and challenging epilepsy syndromes.