BACKGROUND

Super-refractory status epilepticus (SRSE) is a devastating neurological emergency with high morbidity and mortality, and fewer than 10% of survivors achieve full recovery (mRS 0). Epilepsia partialis continua (EPC) as a clinical manifestation of SRSE is rare in adults. Longterm seizure remission after SRSE, especially with documented serial EEG normalization, is seldom reported.

CASE

A 49-year-old woman with no prior comorbidities presented with focal motor seizures of the left upper limb that evolved into EPC and SRSE. The ictal EEG revealed right central (C4) epileptiform discharges correlating with contralateral motor activity and secondary left temporal spread. Despite treatment with multiple antiseizure medications and escalation to triple-anesthetic therapy (midazolam, propofol, thiopental), seizures persisted for six weeks. Complications included suspected propofol infusion syndrome, hypernatremia, stress-related gastrointestinal bleeding, multidrug-resistant pneumonia and bacteremia (K. pneumoniae, P. aeruginosa, MRSA, A. baumannii), thiopental-induced agranulocytosis, and paroxysmal atrial fibrillation. Seizures gradually abated, and she was successfully extubated. Serial EEGs showed progressive resolution, from hemispheric polyspike discharges to normalized alpha rhythm, paralleling recovery. Follow-up MRI revealed resolution of cortical hyperintensities with residual right hippocampal atrophy. Over two years, antiseizure medications were tapered to valproate monotherapy. She remained seizure-free with normal EEGs and full functional independence (mRS 0).

CONCLUSION

This case illustrates a rare trajectory of adult-onset EPC evolving into SRSE with complete neurologic and electrophysiologic recovery. It underscores the value of serial EEG monitoring, vigilant critical care, and long-term follow-up in achieving remission even in resource-limited settings.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Epilepsia Partialis Continua