Acute encephalitis with refractory, repetitive partial seizures: A case report and literature review

A male 46 year-old patient was admitted to the Emergency Intensive Care Unit of Qinghai Provincial People's Hospital (Xining, China) in December 2008 with complaints of a headache and fever that had lasted for three days. In addition, the patient had experienced two general convulsions accompanied with consciousness disorders for 7 h. Although the patient's clinical manifestations, laboratory tests and cerebrospinal fluid examinations were consistent with numerous features associated with acute encephalitis, the patient's clinical course was different to that of acute encephalitis, and the prognosis was poor. The clinical course of the patient fully complied with the diagnostic criteria of acute encephalitis with refractory, repetitive partial seizures (AERRPS), as follows: i) The acute phase of encephalitis lasted >2 weeks; ii) partial seizures accompanied with general seizures occurred throughout the acute and convalescent course; iii) frequent seizures, a number of which resulted in a sustained state, were more prominent in the acute phase; iv) seizures were difficult to control; and v) known viral encephalitis and systemic metabolic disorders were excluded from the diagnosis. Based on previous reports and the present study, it can be concluded that AERRPS does not respond to the majority of anti-epileptic drugs, and while high-dose phenobarbital was effective in the current study, it was not able to fully control the focal and general seizures. Despite this, phenobarbital is required for maintenance in the recovery phase.