A previously healthy 32-year-old man visited our clinic with a 5-week history of
involuntary movement. Examination demonstrated continuous
myoclonic jerks in the left elbow. Two days later, he developed generalized convulsion. Electroencephalography demonstrated small spikes over the right central region. Thus, we made a diagnosis of
epilepsia partialis continua (
EPC) with a secondary generalization. On admission, serum
electrolytes,
glucose and
ceruloplasmin levels, and
amino acid analysis were unremarkable. HIV serology was negative. Anticardiolipin, anti-MPO
ANCA, and anti-Hu
antibodies were negative. The cerebrospinal fluid (CSF) showed 151/microl lymphocytes and 23/microl polymorphs, 70 mg/dl of
glucose, and 61 mg/dl of
protein.
Autoantibodies against the
glutamate receptor subunits epsilon-2 and delta-2 were detected in the serum and CSF. Cranial MRI was unremarkable. Treatment with
acyclovir and high-dose
methylprednisolone failed to halt the jerks. Two weeks after admission, he developed
status epilepticus, which necessitated
general anesthesia.
Intravenous immunoglobulin infusion gave no beneficial effects. Two months after the onset of the
status epilepticus, his convulsions were controlled with
zonisamide,
clobazam, and
carbamazepine. While he had no motor dysfunctions, he had loss of spontaneity and memory impairment. This report suggests that
EPC might be the initial symptom of subacute
encephalitis with a possible autoimmune mechanism.