Focal cortical resection for complex partial status epilepticus due to a paraneoplastic encephalitis

We report a 57-year-old female who presented with epilepsia partialis continua and rapidly progressed to refractory complex partial status epilepticus (CPSE) with brain magnetic resonance imaging revealing a focal cortical lesion on T2 sequences corresponding to the seizure focus on ictal electroencephalographic recordings. The patient underwent focal cortical resection of the seizure focus. Though clinical and electrographic seizure activity ceased, the patient remained unresponsive with repeat neuroimaging showing diffuse limbic and brainstem involvement. Serological tests revealed anti-Hu antibodies suggesting a paraneoplastic encephalitis. Chest computed tomography showed a 5-mm pulmonary nodule and resection of the pulmonary nodule confirmed the diagnosis of small cell lung cancer. Plasmapheresis was performed without clinical improvement. Focal resection can be effective in terminating refractory CPSE but evaluation for a paraneoplastic syndrome must be considered early in the diagnosis of epilepsia partialis continua and CPSE as these patients have a poor prognosis.