Post-herpetic encephalitis presenting with epilepsia partialis continua

Case presentation: Male, 9 years old, healthy, after a dental procedure, he started with clonic seizures on the left side and an episode of tonic-clonic seizure. In the evolution patient developed Epilepsia Partialis Continua (EPC) at the left side. Liquor investigation was positive to herpes virus and despite acyclovir treatment for 21 days patient persisted with seizures. Resonance image demonstrated an atrophic lesion at the left frontobasal region. There was no response to anticrisis medication (phenobarbital, oxcarbazepine, levetiracetam, lacosamide and cannabidiol). A partial response was observed with corticosteroid therapy. Patient underwent left frontal resection with electrocorticography and evolved with complete seizures remission. Anatomopathological was consistent with unspecified gliosis.

Discussion: EPC is a rare condition that is usually reported in patients with chronic brain inflammatory diseases. The main exponent related to this condition is Rasmussen Encephalitis. Natural history consists of an initial infectious or inflammatory peripheral disease that after a latent period evolve to EPC. Our patient had a similar evolution, related to herpetic encephalitis. This presentation form is rarely described in the literature.

Final comments: The present case shows atypical presentation of herpetic encephalitis, progressing to chronic EPC. This case is an example of the challenge in the etiological investigation of patients with epilepsy.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023