REPLY
Chloroquine and Nonconvulsive Status Epilepticus
Paul Mulhauser, MD;
Yves Allemann, MD; and
Claude Regamey, MD
15 March 1996 | Volume 124 Issue 6 | Page 615
IN RESPONSE:
We thank Drs. Benbadis and Van Ness for allowing us to clarify the concept of nonconvulsive status epilepticus. This classification depends on the degree of importance given to clinical signs when defining partial complex status epilepticus and absence status. Some authors claim that it is impossible to differentiate among the various forms of nonconvulsive status epilepticus on clinical grounds [1, 2], whereas others have established criteria for precisely that purpose [3]. Furthermore, Cascino [4] defines two subgroups of complex partial status epilepticus: type I, with repeated but focal EEG alterations, and type II, with either continuous partial or secondarily generalized EEG alterations.
In our patient, EEG criteria alone were insufficient to define her type of epilepsy. Clinically, however, the patient presented with focal signs characterized by motor dysphasia and automatisms that favor a diagnosis of complex partial epilepsy [3]. The EEG results were compatible with the generalized phase of type II complex partial status epilepticus. We excluded the diagnosis of absence status on clinical grounds.
Ultimately, the precise classification of the observed epileptic phenomena in a given subgroup of patients with nonconvulsive status epilepticus does not change the probability that prophylactic doses of chloroquine were responsible for the seizure observed in our patient. Indeed, both partial complex status epilepticus and absence status have been described as secondary to nonfocal cerebral disease [4].
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Author and Article Information
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Hopital Cantonal; 1708 Fribourg; Switzerland
1. Lugarcsi E, Pazzaglia P, Tassinari CA. Differentiation of "absence status" and "temporal lobe status." Epilepsia. 1971; 12:77-87.
2. Porter RJ, Penry JK. Petit mal status. In: Delgads-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ, eds. Advances in Neurology. New York: Raven; 1983:61-70.
3. Rohr-Le Floch J, Gauthier G, Beaumanoir A. Confusional states of epileptic origin. Value of emergency EEG. Rev Neurol (Paris). 1988; 144:6-7, 425-36.
4. Cascino G. Nonconvulsive status epilepticus in adults and children. Epilepsia. 1993; 34(Suppl 1):21-8.
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