Epilepsia partialis continua in a child with disseminated tuberculosis: a case report and review of literature

Tuberculosis can present myriad manifestations, affecting multiple organ systems. Common central nervous system (CNS) manifestations include vomiting, headache, blurred vision, neck stiffness, altered sensorium, seizures, and focal neurological deficits. Epilepsia partialis continua (EPC) is a rare manifestation of CNS tuberculosis. An 11-year-old female patient presented with abnormal twitching movements on the left side, specifically involving the upper limbs, while maintaining full awareness, which is suggestive of EPC. This was preceded by symptoms such as headache, poor appetite, and abdominal pain for 3 months, along with a transient episode of weakness in the left upper limb. An electroencephalogram revealed abundant spike-wave discharges from F8 T4 and C4 P4 in the right hemisphere. The EPC was refractory to anti-seizure medications. Brain MRI revealed multiple contrast-enhancing lesions and magnetic resonance spectroscopy showed a lipid peak that suggested tuberculomas. Further investigations confirmed multisystem involvement, including the gastrointestinal and genitourinary tracts. The treatment of EPC involves addressing the underlying etiology alongside the use of anti-seizure medications. In our patient, the EPC responded well to antitubercular therapy combined with corticosteroids. Given the prevalence of tuberculosis in developing countries, it should be considered early in the differential diagnosis, as it is a treatable cause of EPC.