Monthly Case

A 67-year-old female patient presents for the first time in our epilepsy outpatient clinic at the Charité in April 2016, she is accompanied by a friend. The patient reports that since her 11^th year of life repetitive – often several times per year – stereotyped episodes with some “funny feeling” occur, which she hardly can put into words. Her friend reports that the patient does not react adequately towards external stimuli such as questions or commands. Duration is 1-2 min, no oral or manual automatisms are seen. At onset of seizures in her adolescence, the patient did not dare to talk to her parents about these events. In the further course of her life, the patient has experienced several years without occurrence of these episodes. The patient herself had interpreted these events as “heart attacks”, she has always been something sickish. She had talked multiple times with her general practitioner about these attacks, but he agreed with the patient on cardial events.

In February 2016, one of these episodes occurred in the presence of her adult children. They brought her immediately to the emergency room of a hospital outside of Berlin. The patient was admitted to the department of neurology, and there, these episodes had been judged to be highly suspicious for complex partial epileptic seizures. EEG demonstrated some left temporal slowing but no increased neuronal excitability. Brain MRI was normal. Antiepileptic drug treatment with levetiracetam 2 x 250 mg daily was initiated. Based on the patient’s own and her friend’s description, we did not doubt that these episodes were complex partial seizures and that the patient suffers from cryptogenic partial epilepsy. As we thought that a daily dose of 500 mg levetiracetam is insufficient, we increased the dose to 1,000 mg per day.

Clinical trials on the indigenous population in the Andes have demonstrated that response to the first antiepileptic drug does not differ in patients with long-term frequent seizures compared to new-onset epilepsy. The current patient will present for follow-up in our outpatient clinic in a couple of months which allows to assess a possible treatment success.

Cases of the months before