Epilepsia Partialis Continua Secondary To Ischemic Stroke, Responsive To The Combination Of Levetiracetam And Lacosamide (P4.255)

BACKGROUND: Epilepsia partialis continua (EPC) is commonly resistant to anti-epileptic drugs (AED). It often is a delayed complication of ischemic stroke with no established standard effective treatment . OBJECTIVE: We present two cases of EPC; one with remote history of ischemic stroke (IS) and the other in the setting of subacute IS stroke. Both successfully treated with levetiracetam and lacosamide. METHODS: 2 case reports RESULTS: Case 1: 78 year-old right handed male with history of right temporal parietal IS two and a half years prior with residual left sided weakness and complex partial seizures for 1.5 yrs. He presented with worsening left sided weakness. On the third day of hospitalization, he developed regular left leg and abdomen twitching movements with dysarthria. A continuous EEG recorded right parieto-occipital seizures. Home anti-epileptic medications included lamotrigine 150 mg BID, levetiracetam 1500 mg BID and Phenytoin 200mg BID. Lorazepam was administered on an as needed basis and Lacosamide was initiated and titrated up to 200 mg BID. He became seizure free within five days. Case 2: 73 year-old right handed female had been in a rehabilitation facility for nine days following a right occipital lobe IS, was transferred for management of left sided shaking episodes. She was intubated and sedated for six days at the facility with continued intermittent shaking of her left side and trunk. Continuous EEG recording, while intubated and sedated, demonstrated EPC of right fronto-central origin. Seizure freedom was attained 2 days after starting and titrating levetiracetam to 1000 mg BID and lacosamide to 100mg BID. CONCLUSIONS: EPC represents a condition commonly refractory to AED. We report two cases of EPC secondary to subacute and chronic IS that showed responsiveness to the combination of levetiracetam and lacosamide. Further evaluation of this AED combination in treating this difficult condition is needed.