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Chloroquine and Nonconvulsive Status Epilepticus
- Selim R. Benbadis, MD; and
- Paul C. Van Ness, MD
- Medical College of Wisconsin; Milwaukee, WI 53226 University of Texas Southwestern Medical Center; Dallas, TX 75235
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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.
Paul C. Van Ness, MD
University of Texas Southwestern Medical Center
Dallas, TX 75235
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
