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Complex Partial Status Epilepticus: Two Case Reports

Complex partial status epilepticus (CPSE), also known as temporal lobe or psychomotor status epilepticus, may present as a prolonged confusional state or as a fluctuating level of consciousness. Only a few well-documented cases have been reported in the literature. There are some differences of opinion regarding the documented cases of CPSE in the literature because of lack of agreement as to diagnostic criteria. Two cases are generally accepted as genuine and about fifteen others are possible. Two types of CPSE have been recognized. One form refers to a series of complex partial seizures (CPSs) with post-ictal confusion extending throughout the period between seizures. These frequently recurring CPSs are associated with repetitive episodes of complex symptomatology and an EEG seizure pattern that has a focal (usually temporal lobe) origin. During the period of continuous post-ictal confusion the EEG would be expected to show focal or generalized slowing. The second form of CPSE is defined as a prolonged CPS with continuous complex symptoms. This is characterized clinically by prolonged periods of confusion or psychotic behavior or automatisms, and electroencephalographically by a continuous seizure pattern which either remains focal or is secondarily generalized from a focal pacemaker. The classification of CPSE into prolonged and repetitive CPSs is convenient. Recently transitions from one form to the other have been recognized by the use of in-depth electrodes. 1 This article deals with two case reports of CPSE presenting as prolonged confusional episodes that were documented both clinically and electroencephalographically.