Abstract:
This chapter presents the case of a man diagnosed with Epilepsia partialis continua (EPC) involving the left deltoid muscle. The unusual features of this patient's left shoulder twitching raised the possibility that this event was nonepileptic in origin. The observed left shoulder twitching caused his proximal arm to move in an irregular manner. There was no clonic twitching in the proximal or distal arm or hand. The left shoulder twitching ceased when he was asleep or distracted. The twitching increased if he was asked to move his left arm voluntarily. The EPC persisted despite a phenytoin level of 18 μg-ml. A magnetic resonance imaging (MRI) scan with gadolinium enhancement revealed a large ring-enhancing lesion involving the high convexity of the right parietal lobe with significant surrounding edema. A brain abscess was suspected, and the patient was brought to the operating room for right parietal craniotomy and needle aspiration of the lesion. Neuropathology confirmed the presence of a brain abscess. He has had no further seizures since his surgery. © 2008 Elsevier Inc. All rights reserved.