Monthly Case

A 69-year-old male patient had a first sleep-bound generalized tonic-clonic seizure 2 years ago. Brain MRI revealed moderate vascular leukencephalopathy, some lacunar lesions were located closely to cortical structures. Routine EEG was normal. In this constellation, it is likely that the microangiopathic cerebral lesions are the cause for this patient’s first seizure. The risk for another epileptic seizure within the next 10 years is approximately 70%, this defines epilepsy, and in the current case focal epilepsy. Due to the high recurrence risk, we recommended to the patient treatment with the antiepileptic drug levetiracetam at 1,000 mg daily, actually this is a secondary prophylaxis. The substance was well tolerated, but after 1 year, the patient asked to stop levetiracetam. We explained to the patient that the risk for another epileptic seizure after withdrawal is above 50%. But still, the patient wanted to stop the antiepileptic drug. At first, he remained seizure free but after 1 year he had a second generalized tonic-clonic seizure out of sleep. After that, the patient himself understood that from now on he has to take an antiepileptic drug, he wanted to restart levetiracetam.

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