LETTER
Chloroquine and Nonconvulsive Status Epilepticus
Selim R. Benbadis, MD, and
Paul C. Van Ness, MD
15 March 1996 | Volume 124 Issue 6 | Page 614
TO THE EDITOR:
We read with interest the report by Mulhauser and colleagues on chloroquine-induced nonconvulsive status epilepticus [1]. We agree that the clinical picture is consistent with the diagnosis of nonconvulsive status epilepticus. The segment of the electroencephalogram (EEG) shown in their report, by its strict appearance, is not diagnostic, but we agree that the dramatic resolution of the electroclinical picture with intravenous benzodiazepine provides compelling evidence for the diagnosis of status epilepticus.
However, we dispute the authors' contention that this case represents complex partial status epilepticus. Although the picture is consistent with that diagnosis, it is more suggestive of a diagnosis of generalized nonconvulsive status epilepticus (petit mal status or spike-wave stupor) [2, 3]. Unless the EEG showed a clear focal discharge at onset (which is unlikely, given that the EEG was done late in the course of the symptoms), the diagnosis of partial status epilepticus is also unlikely. No asymmetry suggesting a focal onset can be seen in Figure 1 of Mulhauser and colleagues' letter. The EEG showed a generalized pattern with frontal predominance, as is the case in most generalized spikes or spike-wave complexes [4]. Furthermore, a generalized seizure pattern would be more consistent with the toxic cause suspected here, and "de novo" absence status has previously been associated with many toxic or metabolic abnormalities [5].
Although not applicable in this case, the common tendency to label seizures (or status) as partial in the presence of little or no evidence is potentially harmful because it may provide grounds to initiate evaluations for possible epilepsy surgery. When it is unclear whether the nature of a seizure (or status) is focal or generalized, we believe extrapolation is unwise. In this case, the term "nonconvulsive" was more appropriate than "complex partial" status epilepticus.
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Author and Article Information
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Medical College of Wisconsin; Milwaukee, WI 53226
University of Texas Southwestern Medical Center; Dallas, TX 75235
1. Mulhauser P, Allemann Y, Regamey C. Chloroquine and nonconvulsive status epilepticus [Letter]. Ann Intern Med. 1995; 123:76-7.
2. Gastaut H. Classification of status epilepticus. In: Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ, eds. Advances in Neurology. New Y ork: Raven; 1983:15-35.
3. Porter RJ, Penry JK. Petit mal status. In: Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ, eds. Advances in Neurology. New York: Raven; 1983:61-7.
4. Daly DD. Epilepsy and syncope. In: Pedley TA, Daly DD, eds. Current Practice of Clinical Electroencephalography. New York: Raven; 1990:269-34.
5. Thomas P, Beaumanoir A, Genton P, Dolisi C, Chatel M. "De novo" absence status of late onset: report of 11 cases. Neurology. 1992; 42:104-10.
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