Idiopathic catastrophic epileptic encephalopathy presenting with acute onset intractable status

PURPOSE To delineate a catastrophic childhood epileptic syndrome of unknown cause presenting with persistent intractable multifocal status. METHODS Case note review. RESULTS Six children aged 5 months to 6 years presented with focal seizures that progressed within days to intractable multifocal seizures with or without secondary generalisation, which recurred every few minutes and persisted for weeks. One developed impaired consciousness shortly before seizures started. The two younger children showed mild developmental delay before onset but the others were normal. The seizures were unresponsive to all conventional anticonvulsants, steroids or pyridoxine and could only be controlled with doses of thiopentone sufficient to cause electrical suppression. MRI scans were initially normal but later showed focal cortical swelling followed by generalised atrophy. Two developed hepatomegaly, with a normal liver biopsy in one and steatosis in the other. No cause has been found even after neuropathological investigation. Three have died, two within 3 months of onset, while the three survivors have very severe neurological impairment and continued seizures. CONCLUSION The similarity of the clinical features suggests that this is a consistent clinical syndrome.