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Epilepsia Partialis Continua – Autoimmune Workup — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersEpilepsia Partialis Continua – Autoimmune WorkupSCE Neurology

A 45-year-old man presents with epilepsia partialis continua — continuous focal motor seizures affecting the right hand for 72 hours. He is alert and oriented. MRI brain shows a left perirolandic cortical lesion with T2/FLAIR hyperintensity. IV lorazepam and IV levetiracetam have not stopped the seizures. What is the most important investigation to perform urgently?

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Correct answer: E — Autoimmune encephalitis antibody panel and brain biopsy consideration — to exclude Rasmussen encephalitis or autoimmune aetiology

Epilepsia partialis continua (EPC) — continuous focal motor seizures — has a limited differential diagnosis including Rasmussen encephalitis (chronic, progressive, unilateral encephalitis causing EPC, hemiparesis, and hemispheric atrophy), autoimmune encephalitis (anti-NMDAR, anti-GAD65), focal cortical dysplasia, mitochondrial disease (MELAS), and cortical tumours. An autoimmune encephalitis antibody panel (serum and CSF) is essential. If Rasmussen encephalitis is suspected, brain biopsy may be needed. A: Copper deficiency does not cause EPC. C: Prolactin is for seizure classification, not aetiology. D: Carotid Doppler is irrelevant. E: Viral PCR alone is insufficient.

Reference: ABN Autoimmune Encephalitis Guidelines; Bien et al. Rasmussen Encephalitis Consensus (2005)