PMID- 10214739
OWN - NLM
STAT- MEDLINE
DCOM- 19990512
LR  - 20220321
IS  - 0028-3878 (Print)
IS  - 0028-3878 (Linking)
VI  - 52
IP  - 6
DP  - 1999 Apr 12
TI  - Nonconvulsive status epilepticus of frontal origin.
PG  - 1174-83
AB  - OBJECTIVES: To determine the electroclinical characteristics and causative 
      factors of nonconvulsive status epilepticus (NCSE) of frontal origin. METHODS: 
      The authors conducted a 5-year prospective study. RESULTS: Ten patients were 
      studied (seven men, three women; mean age, 56.4 years). Six patients did not have 
      previous epilepsy. The mean diagnostic delay was 48 hours (range, 3 to 96 hours). 
      Two types of frontal NCSE were identified. In type 1 (n = 7), mood disturbances 
      with affective disinhibition or affective indifference were associated with 
      subtle impairment of cognitive functions without overt confusion. EEG showed a 
      unilateral frontal ictal pattern and normal background activity. In type 2 (n = 
      3), impaired consciousness was associated with bilateral, asymmetric frontal EEG 
      discharges occurring on an abnormal background. Ictal and postictal 99mTc 
      hexamethyl propylene amine oxime (HMPAO) SPECT was performed in five patients and 
      showed unilateral or bilateral frontal HMPAO uptake that aided localization, 
      especially in type 2 NCSE of frontal origin. Etiologies included a focal frontal 
      lesion in six patients (three of which were tumors), neurosyphilis, and 
      nonketotic hyperglycemia. Eight patients did not respond to initial IV 
      benzodiazepine (BZ), but IV phenytoin controlled six patients successfully. The 
      immediate outcome was favorable in all patients. There was no long-term 
      recurrence of SE in seven patients. CONCLUSIONS: NCSE of frontal origin is a 
      heterogeneous syndrome. Some cases are best described as simple partial NCSE, 
      others as complex partial SE, and there are forms that overlap with absence SE. 
      Emergency EEG and neuropsychological assessment are diagnostic, and SPECT may be 
      useful. Many patients may not respond to IV BZ.
FAU - Thomas, P
AU  - Thomas P
AD  - Service de Neurologie, Hopital Pasteur, Nice, France. piertho@calva.net
FAU - Zifkin, B
AU  - Zifkin B
FAU - Migneco, O
AU  - Migneco O
FAU - Lebrun, C
AU  - Lebrun C
FAU - Darcourt, J
AU  - Darcourt J
FAU - Andermann, F
AU  - Andermann F
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
SB  - IM
MH  - Adult
MH  - Aged
MH  - Electroencephalography
MH  - Female
MH  - Frontal Lobe/diagnostic imaging/*physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Status Epilepticus/diagnostic imaging/*physiopathology
MH  - Tomography, Emission-Computed, Single-Photon
EDAT- 1999/04/24 00:00
MHDA- 1999/04/24 00:01
CRDT- 1999/04/24 00:00
PHST- 1999/04/24 00:00 [pubmed]
PHST- 1999/04/24 00:01 [medline]
PHST- 1999/04/24 00:00 [entrez]
AID - 10.1212/wnl.52.6.1174 [doi]
PST - ppublish
SO  - Neurology. 1999 Apr 12;52(6):1174-83. doi: 10.1212/wnl.52.6.1174.