Abstract:
This chapter examines the case of a teenager diagnosed with nonconvulsive status epilepticus of frontal lobe origin. The 17-year-old woman's medical illness started in February 2000 when she was diagnosed with a left frontal abscess complicating a pansinusitis. She underwent a left frontal craniotomy with an evacuation of the left frontal brain abscess and her sinuses. Perioperatively, she was treated with antibiotics and put on phenytoin prophylaxis for 3 weeks. She was admitted to the hospital for an evaluation. During the 3 days of monitoring, her awake EEG revealed well-modulated posterior 8-9 Hz activity, a left frontal breach rhythm, continuous slowing over the left frontal region, and intermittent bifrontal spikewave activity, which occurred occasionally in bursts of up to 5 s; in addition, a total of five electrographic partial seizures without clinical accompaniment were recorded. On the insistence of the patient and her mother, she was discharged home the next day on levetiracetam 1500 mg-day and divalproex 1250 mg-day. A brain magnetic resonance imaging scan showed an area of encephalomalacia in the left frontal lobe at the site of her known previous abscess. On the combination of levetiracetam 3000 mg-day and divalproex 1500 mg-day she was seizure-free on prolonged EEG monitoring and her personality returned to baseline. The interesting feature of this case was the dissociation between the electrographic findings and the clinical manifestations. Status epilepticus is a medical emergency that requires immediate and aggressive treatment in order to prevent mortality or significant morbidity. Nonconvulsive status epilepticus is usually suspected when there is a sudden and persistent change in mental status or behavior and confirmed by EEG. © 2008 Elsevier Inc.