From the Research
Epilepsia partialis continua should be treated with first-line fosphenytoin, followed by clobazam, and then either valproate or levetiracetam, as these medications have been shown to be effective in managing this condition 1.
Treatment Overview
Epilepsia partialis continua is a rare form of focal status epilepticus characterized by continuous or repeated focal motor seizures affecting a limited part of the body, typically the face, arm, or leg, that can persist for hours, days, or even weeks without stopping.
- The treatment of epilepsia partialis continua typically begins with antiepileptic medications such as benzodiazepines, followed by loading doses of second-line agents like levetiracetam, valproate, or phenytoin.
- For refractory cases, continuous infusions of midazolam, propofol, or ketamine may be necessary.
- The underlying cause must be identified and treated, as epilepsia partialis continua often results from structural brain lesions, stroke, encephalitis, metabolic disorders, or Rasmussen's encephalitis.
Key Considerations
- Prompt treatment is essential as prolonged seizures can lead to neuronal damage and cognitive impairment.
- Patients may require hospitalization for monitoring and management, particularly if consciousness is affected or if seizures are resistant to initial treatments.
- The use of antiseizure medications can be associated with complications, including aspiration pneumonia, encephalopathy, and respiratory failure, and therefore should be used judiciously 1.
Management Strategies
- A systematic review of the literature found that first-line fosphenytoin, followed by clobazam, and then either valproate or levetiracetam, was an effective treatment strategy for epilepsia partialis continua 1.
- Other adjunctive treatments, such as lacosamide, topiramate, and carbamazepine, may also be effective in managing this condition.
- Perampanel has also been shown to be a promising therapeutic option for treating epilepsia partialis continua, particularly in pediatric patients 2.