Epilepsia partialis continua beyond status epilepticus: a generator-based neurophysiological framework for clinical...

Area of Science:

• Neuroscience
• Clinical Neurology
• Epileptology

Background:

• Epilepsia Partialis Continua (EPC) presents heterogeneous clinical courses and treatment responses.
• Current classifications based on etiology or duration inadequately capture EPC's neurophysiological underpinnings.
• Variability in systemic involvement and treatment response necessitates a refined classification system.

Purpose of the Study:

• To propose a novel generator-based neurophysiological framework for classifying EPC.
• To re-evaluate EPC based on the biological stability of the epileptic generator and network interactions.
• To delineate distinct EPC phenotypes with different clinical trajectories and management implications.

Main Methods:

• Integration of electrophysiological principles, clinical EEG-EMG data, and existing literature.
• Development of a framework prioritizing epileptic generator stability and network engagement.
• Delineation of three principal EPC phenotypes: State-Stable EPC (SS-EPC), Status Epilepticus-associated EPC (SE-EPC), and Multifocal Progressive EPC (MP-EPC).

Main Results:

• Three distinct EPC phenotypes are identified based on generator stability and network recruitment.
• SS-EPC involves a stable generator with limited network spread.
• SE-EPC is linked to unstable, recruiting networks and increased systemic risk.
• MP-EPC reflects progressive, multifocal epileptogenic system expansion.

Conclusions:

• The proposed generator-based framework provides a coherent biological rationale for EPC classification.
• This classification differentiates presentations with distinct clinical trajectories and management needs.
• Prioritizing generator stability and network engagement supports physiology-based clinical decision-making, optimizing therapeutic strategies.