Abstracts

RATIONALE: Epilepsia partialis continua (EPC) is poorly responsive to any pharmacotherapy. Based on experimental evidence that NMDA blockers may be effective in some types of anticonvulsant-refractory status epilepticus (Mazarati/Wasterlain, , we tried felbamate and report here two cases of successful treatment with oral felbamate. METHODS: 1/ A 41 y.o. male with a large, stable cavernous angioma of the right hemisphere (and seizures starting at age 2; at 24 he accidentally amputated his right thumb and index during a complex partial seizure) developped epilepsia partialis continua in his left hand, with interictal paralysis. He threatened suicide because of the resulting disability. EPC was resistant to large amonnts of primidone, clorazepate and topiramate. He previously failed phenytoin, phenobarbital, carbamazepine, valproate, and gabapentin. Work-up including MRI showed no new lesion, no progression of the angioma and no recent bleed. 2/ A 20 yo female without known brain disease or structural lesion on MRI had EPC of her left arm and hand since age 15, unresponsive to valproate, carbamazepine and clonazepam. RESULTS: In patient 1, felbamate was titrated up to 3600 mg/day, EPC slowed then stopped, and did not return when felbamate was tapered over 6 weeks. He regained full power in his left hand and EPC has not returned 16 months later. Patient 2 achieved good control with felbamate but EPC returned when it was discontinued a year later because of concern about reports of hematotoxicity. EPC is still present 7 years later. CONCLUSIONS: This is the second report of successful felbamate use in EPC (Echenne et al, Epilepsia, 38: S3, 36, 1997). In view of the experimental evidence that self-sustaining, anticonvulsant-refractory status epilepticus is maintained by potentiation of NMDA synapses (Mazarati/Wasterlain, Neurosci. Lett.,265; 187-190, 1999), the use of NMDA blockers available in the US pharmacopoeia (felbamate, ketamine) should be considered in EPC refractory to standard anticonvulsants.