DE-NOVO EPILEPTIC CONFUSIONAL STATUS IN A PATIENT WITH COBALAMIN DEFICIENCY

A 80-year-old man with cobalamin deficiency and no history of epilepsy developed a partial complex epileptic confusional status (ECS) unresp onsive to acute i.v. diazepam. Brain CT scan and MRI investigation rul ed out a focal cerebral lesion. Therapy with high doses (10,000 mu g i .m. daily) of cobalamin alone was started, and the patient fully recov ered in the following 72-hour. Control EEGs repeatedly performed days and weeks later showed progressive disappearance of the frontal interi ctal spiking, while the patient was on monotherapy with cobalamin (5,0 00 mu g i.m. weekly). A month later the patient unfortunately disconti nued replacement therapy and 13 weeks later he developed a fatal convu lsive epileptic status. To our knowledge the association of ECS and co balamin-deficiency has not been previously reported.