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

Epilepsia Partialis Continua (EPC) is traditionally classified as a focal motor form of status epilepticus, yet its clinical course and therapeutic needs are remarkably heterogeneous. Current classification strategies, largely based on etiology, duration, or temporal evolution, do not adequately reflect the underlying neurophysiological organization of the epileptic system or explain the variability in systemic involvement and treatment response observed in practice. This review proposes a generator-based neurophysiological framework that reinterprets EPC according to the biological stability of the epileptic generator and its interaction with epileptic networks. Integrating established electrophysiological principles, clinical EEG-EMG observations, and available literature, three principal phenotypes are delineated: State-Stable EPC (SS-EPC), characterized by a spatially confined and biologically stable generator with limited network recruitment; Status Epilepticus-associated EPC (SE-EPC), occurring within an unstable and recruiting epileptic network associated with higher systemic risk; and Multifocal Progressive EPC (MP-EPC), reflecting the longitudinal expansion of multifocal epileptogenic systems in progressive neurological disorders. These phenotypes offer a coherent biological rationale for distinguishing EPC presentations with fundamentally different clinical trajectories and management implications. By prioritizing generator stability and network engagement, this perspective supports physiology-based clinical decision-making and may help avoid unnecessary therapeutic escalation in biologically stable forms while promoting timely intensive management in unstable network-driven states.