Combined partial temporal and secondary generalized status epilepticus. Report of a case with fear bouts followed by prolonged confusion.

A right-handed 32-year-old woman had recurrent combined partial temporal and secondary generalized epileptic states almost constantly related to menstruations. During such more or less prolonged episodes sometimes the patient presented right adversive attacks with short postictal dysphasia. The catamenial status epilepticus observed in this cas was manifested in two clear-cut behavioral phases. The first phase was characterized by frequently recurrent left temporal epileptiform discharges without tendency to diffusion, progressively more prolonged and pseudorhythmic associated with a signalized feeling of intense fear without apparent impairment of consciousness or speech disturbances. The electroclinical features of the first phase suggest a depth origin of the paroxysms, probably due to a primary epileptogenic focus in the left amygdaloid-hippocampal complex. In the second phase the left temporal focal semirhythmic discharges associated with fear bouts became more frequent and prolonged and began to be followed by long-lasting generalized discharges resulting in a trance-like state with severe impairment of consciousness. The diffuse paroxysmal activity regularly preceded by the left temporal focal discharges was interpreted as a form of secondary bilateral synchrony constantly triggered from a focal pacemaker represented by the primary epileptogenic focus. During the very short transient periods of sudden cessation of the epileptiform activity the patient returned immediately to an apparent normal mental state. Good correlation could be established between different seizure patterns and predominant clinical signs. Intravenous diazepam rapidly decreased and then completely stopped the catamenial status epilepticus. Some problems related to the classification of these rare epileptic events are discussed.