Researchers suggest that epilepsia partialis continua (EPC) in relapsing-remitting multiple sclerosis (RRMS) may represent a distinct relapse phenotype, as published in Clinical Neurology & Neurosurgery.
The case report was of a 35-year-old woman who presented with continuous left-hand jerking, which was compatible with EPC. Her past medical history revealed a diagnosis of RRMS and 2 previous episodes of EPC. Upon presentation, her medication included lacosamide 200 mg PO BID.
In terms of her past episodes of EPC, the first occurred 5 years prior, in which she experienced right-hand EPC for a total of 6 days, culminating in a generalized tonic-clonic seizure that resolved spontaneously.
The second episode occurred 2 years prior, in which she experienced right-hand EPC for 5 days that eventually resolved with methylprednisolone 1g intravenous daily given for 3 days. Brain magnetic resonance imaging (MRI) of both EPC episodes was unremarkable.
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“[Electroencephalography] at the time of her current presentation showed no epileptiform activity, but concurrent surface [electromyography] over the left extensor pollicis longus captured continuous, brief (~30 ms), irregular jerks consistent with EPC,” Jain et al wrote.
The physicians repeated brain and cervical spine MRI with gadolinium and no new lesions were found. The patient was then prescribed 3 days of methylprednisolone 1g intravenous daily. The left-hand EPC resolved after the second dose.
This patient was the first case known to the authors of this study of a patient with MS experiencing multiple episodes of EPC involving more than 1 body part.
“The association with relapsing-remitting disease, corticosteroid-responsiveness, and dissemination of recurrent episodes of EPC in both space and time in our case suggest that EPC in RRMS may represent a distinct relapse phenotype,” Jain and colleagues concluded.
Jain J, Son M, Debicki DB, et al. Epilepsia partialis continua in relapsing-remitting multiple sclerosis: a possible distinct relapse phenotype. Clin Neurol Neurosurg. 2021;213(21). doi:10.1016/j.clineuro.2021.107099