John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the

Probable dysimmune epilepsia partialis continua manifesting as epileptic moving toes syndrome: electroclinical features of a challenging case Volume 20, issue 4, August 2018

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  • Probable dysimmune epilepsia partialis continua manifesting as epileptic moving toes syndrome: electroclinical features of a challenging case
  • Probable dysimmune epilepsia partialis continua manifesting as epileptic moving toes syndrome: electroclinical features of a challenging case
  • Probable dysimmune epilepsia partialis continua manifesting as epileptic moving toes syndrome: electroclinical features of a challenging case
  • Probable dysimmune epilepsia partialis continua manifesting as epileptic moving toes syndrome: electroclinical features of a challenging case

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Authors
1 Department of Neurosciences, Biomedicine and Movement Sciences. University of Verona, Italy
2 Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
3 Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
4 Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg Austria
5 Centre for Cognitive Neuroscience Salzburg, Austria
6 Department of Public Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall.i.T., Austria
* Correspondence: Francesco Brigo Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10 - 37134 Verona, Italy
a Authors contributed equally
  • Key words: autoimmune encephalitis, diagnosis, epilepsia partialis continua, painful legs and moving toes syndrome
  • DOI : 10.1684/epd.2018.0983
  • Page(s) : 301-12
  • Published in: 2018

Epilepsia partialis continua(EPC) is a rare form of focal status epilepticus. We describe a 22-year-old woman with EPC manifesting with isolated toe movements, prevalent over the left side and initially misdiagnosed as psychogenic, clinically almost indistinguishable from those observed in “painful legs and moving toes syndrome”. The continuous involuntary movements with EMG correlates of twitches lasting <100 ms, the sharp waves over fronto-central regions on EEG, and the marked asymmetry in somatosensory evoked potentials with higher cortical amplitude over the right side following peripheral stimulation over the left foot confirmed the epileptic nature of the symptoms, leading to the diagnosis of EPC. The toe movements were markedly reduced following steroid therapy, whereas the infusion of immunoglobulins caused aseptic meningitis. Despite an extensive diagnostic work-up (including a search for antibodies for paraneoplastic and autoimmune encephalitis), an ultimate aetiological diagnosis was not reached, although the dramatic response to corticosteroids strongly supported an underlying dysimmune pathophysiology. Diagnosing EPC can be challenging, especially if movements are confined to a very small body region or strongly resemble movements encountered in other conditions. EEG-EMG monitoring should be performed in patients with continuous involuntary muscular jerks in order not to overlook a diagnosis of EPC. [Published with video sequences on www.epilepticdisorders.com].