Monthly Case

… a 38-year-old female patient had suffered in the previous 20 years, not realizing that these were epileptic seizures.

Since 17 years of age, the patient has experienced episodes with an initial perception of familiarity which is followed by short absences. The patient did not attach these –approximately weekly manifesting – episodes too much importance, subjectively these did not have any clinical relevance to her. Also third parties did not have the impression that these episodes presented a relevant medical problem. Due to a concomitant depressive disorder, the patient has started regular psychotherapy 3 years ago. The patient had reported her psychotherapist these “funny” episodes, but the latter attributed those to dissociative (= psychogenic non-epileptic) seizures.

Eventually, the patient presented to a neurologist due to persistent tension-type headache, who transfered the patient under the suspicion of epileptic seizures for further diagnostic procedures and treatment to our epilepsy-center. Just based on the patient’s description of her seizures, we were able to make the diagnosis of partial epilepsy with déjà vu auras and automotor (= complex partial) seizures. A brain MRI was normal, thus etiologically the epilepsy is cryptogenic.

We initiated antiepileptic drug treatment with lamotrigine which – along with levetiracetam – is recommended in the guidelines of the German Neurological Society as first-choice treatment for partial epilepsy. Due to the depressive symptoms, we decided against levetiracetam. With achieving the target dose of 150 mg daily, the patient was free of epileptic seizures.

This case presentation is of interest for two reasons. Firstly, any short-lasting paroxysmal events with alterations of perception and/or absences should be presented to a neurologist, ideally one of those specialized in epilepsy. Secondly, response to new-onset antiepileptic drug treatment after multiple – as in the current case more than 1,000 – epileptic seizures is as good as after 1 or 2 seizures. This also has been demonstrated in a large group of indigenous people with long-lasting untreated epilepsies from the Andes Mountains. Thus, repetitive epileptic seizures in humans don’t render the brain “more epileptic”, as it had been assumed in former times.

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