Prefrontal disturbances as the sole manifestation of simple partial nonconvulsive status epilepticus

We describe a case of frontal lobe epilepsy with rare nocturnal generalized tonic-clonic seizures and repeated prolonged episodes of altered behavior lasting 1 to 2 days. The changes consisted of poor organizational strategies, impaired set shifting, emotional indifference, reduced motivation, and impairment of emotional decision making. Memory and consciousness were undisturbed, as she was able to follow her profession as a teacher. During the episode, the EEG was marked by right frontal rhythmical spikes and waves with spread to the homologous left region. Behavioral abnormalities and EEG changes were successfully treated with intravenous diazepam. The clinical representation can be ascribed to alterations of prefrontal-subcortical circuits, especially the anterior cingulate and orbitofrontal circuits. This unique case is classified as simple partial nonconvulsive status epilepticus with prefrontal disturbances as the sole manifestation.