| Popis: |
Publisher Summary This chapter highlights a case in which the patient had frontal lobe seizures with an interhemispheric focus that precluded epileptiform activity from being seen on the EEG. The 32-year-old white woman presented with a history of “seizures” starting at the age of 8. These were diagnosed as “petit mal.” At the age of 16 she began having “night seizures.” Despite being treated with numerous medications the events continued unchanged. EEG video-telemetry was carried out and multiple bizarre events were recorded. These events consisted of posturing of the upper extremity, gesturing and, on one occasion, a backward roll over the edge of the bed rail, which resulted in the patient falling out of bed. The patient was noted to have been seizure-free for 8 months on topiramate 400 mg/day and tiagabine 20 mg/day. This was really very remarkable since she had in the past experienced 25–30 seizures in a day. She had no side effects from the medication and was doing very well. This patient initially presented with a very confusing clinical picture. Her spells were described as screaming, kicking, and moving her arms. Because of a strong family psychiatric history, the unusual character of her seizures, normal EEGs and coexisting anxiety disorder, she was thought by many to have nonepileptic seizures and sleep parasomnia syndrome. The epileptic etiology for her spells became apparent after video-EEG monitoring. Even though the ictal EEG was normal the clinical manifestations were those of frontal lobe motor association seizures. Subsequently, we felt more comfortable employing a more vigorous therapeutic approach, maximizing drug doses until side effects were encountered. |
