[A case of severe status epilepticus of frontal lobe origin successfully treated with corticosteroids]

A 17-year-old girl was admitted to our hospital due to low-grade fever, confusion, numbness in her right hand and automatism. On admission, she was slightly disoriented but there were no meningeal signs. Weakness and sensory disturbance were observed in her right hand. Automatism and clonic seizures frequently appeared. Electroencephalography revealed frequent delta bursts in her left frontal lobe. 123I-IMP-SPECT study showed abnormally increased isotope uptake in the left cerebral hemisphere. She was diagnosed as status epilepticus of left frontal lobe origin and treated with anti-convulsants including carbamazepine, phenytoin, diazepam, phenobarbital, and thiopental, which were not effective. Then we started corticosteroid therapy. Three cycles of intravenous injections of methylprednisolone, followed by oral prednisolone led to marked improvement in her symptoms. It is known that corticosteroid decreases the threshold of seizure, so we do not use it for idiopathic epilepsy. On the other hand, in some secondary epilepsy due to vasculitis in the brain, corticosteroid is very effective for seizures. It is still unclear whether our patient actually had vasculitis or not. However, it is important to recognize that steroid therapy might be effective in a certain portion of epilepsies resistant to anti-convulsants, especially in young patients with non-infectious fever.