"A Case Solved by Seizures During Sleep"
IN: Puzzling Cases of Epilepsy / Schmidt, Dieter; Schachter, Steven C (Eds)
New York, NY : Academic, 2008
- This chapter deals with the case of a woman diagnosed with frontal lobe complex partial seizures. She was treated through her childhood with phenobarbital, carbamazepine, phenytoin, and primidone. By her adolescence, the patient's seizures had changed in character. They were now described as thrashing, rocking back and forth, at times striking out in a seemingly purposeful way, and injuring herself, with resultant ecchymoses of the elbow and forehead. Seizures also increased in frequency. Medication included primidone, valproate, and phenytoin. Multiple nocturnal events were recorded. These events had identical clinical characteristics as had been seen during the first monitoring session and, again, no ictal or interictal EEG changes were noted. However, some events occurred directly out of stage 2 sleep, and the patient returned directly to sleep afterward. This prompted subsequent intracranial EEG monitoring, which confirmed that both the diurnal and the nocturnal events were frontal lobe complex partial seizures. If a diagnosis of frontal lobe complex partial seizures is confirmed and the patient has been demonstrated to be refractory to antiepileptic drug therapy, referral for surgical management should be considered. Up to 67% of patients with an identified frontal focus may become seizure-free after surgical resection.
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