Abdominal epilepsia partialis continua in a patient with astrocytoma treated with Lacosamide - value of repetitive EEG recordings.

OBJECTIVE: Isolated abdominal epilepsia partialis continua (EPC) without the involvement of other body parts is rarely seen. Abdominal EPC usually occurs either as a part of hemibody EPC or as an evolution of refractory EPC after initial treatment. As the isolated abdominal EPC was rarely reported up to date, the data regarding its pathophysiology and management are limited. Herein, we aimed to describe the clinical, neuroimaging, and electroencephalographic findings of a patient with abdominal EPC.

PATIENTS AND METHODS: A 48-year-old woman with a history of surgical resection for right posterior frontal astrocytoma was admitted with left abdominal EPC. Magnetic resonance imaging of the brain showed a residual mass lesion and encephalomalacia in the right frontoparietal region.

RESULTS: Although the initial electroencephalography (EEG) was normal, independent spikes were detected in the right frontal and parietal derivations in the second EEG. Although her EPC was refractory to levetiracetam, lamotrigine, phenytoin, and gabapentin, oral lacosamide treatment ceased the seizures.

CONCLUSIONS: The history of this patient emphasizes the necessity of repetitive recordings in case of a normal initial EEG. The independent spikes in her frontal and parietal regions suggested the presence of a large epileptogenic zone generating independent epileptiform activities in the pre-central motor cortex and the post-central sensory cortex as the pathophysiologic phenomena in persistent abdominal EPC. To the best of our knowledge, this is the first report presenting a patient experiencing an abdominal EPC due to a cerebral mass resolved with lacosamide suggesting this drug is a promising treatment option in resistant EPC.