Monthly Case

A 57-year-old lady from Russia with limited German language capabilities was admitted to our Epilepsy-Center in order to clarify if subjective paroxysmal events were of epileptic origin or not. The patient reported nausea and headaches with almost daily frequency. More detailed information was not available, in particular not on the duration of paroxysmal events. Third party history on semiology did not contribute to clarification of diagnosis. On admittance, the patient was treated with 50 mg topiramate and 100 mg lacosamide. Higher dosages were not tolerated, withdrawal of one of these substances resulted in increased frequency of events.

24-h-longterm video-EEG did not detect any seizures, interictal EEG was unremarkable as well. Brain MRI revealed mild vascular leukencephalopathy. We decided to stop both antiepileptic drugs. The following days, while she was still in-patient in our center, the patient did not report any paroxysmal events.

At the evening of the day the patient was discharged from hospital, her daughter observed a seizure with starring, smacking and chewing, and unresponsiveness, duration was 1 min. The patient was amnesic for this seizure, she merely reported headaches. The daughter’s description allowed allocating this event to an epileptic automotor seizure. The patient was started on lamotrigine.

In summary, we assume that the majority of her paroxysmal events characterized by nausea are not epileptic seizures. Nonetheless, the patient unequivocally suffers from additional epileptic seizures. These may be associated with postictal headache, that has been reported by more than one third of patients with epilepsy.

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