Monthly Case

A 22-year-old female patient for the first time presents in our epilepsy outpatient department. Since the age of 16 years, she suffers from regularly occurring seizures that are characterized by loss of contact and non-reagibility as well as prominent oral and manual automatisms. From a semiological point of view, these are typical automotor (= complex partial) epileptic seizures. Frequency is 1-2 per month. Etiology is unclear, at epilepsy onset she had an MRI, but she neither has the images nor the written report. The patient is otherwise healthy, she is working as office clerk.

At presentation in our outpatient clinic, the patient was treated with levetiracetam 2 x 1,500 mg daily. At epilepsy onset, she had been treated with oxcarbazepine, this had had to be tapered after 2 weeks due to significant side effects (details unclear). The patient now presented on her own decision in our clinic asking if her epilepsy could be treated better than now. Her previous doctor had told her, that she can be happy with her current treatment, as other patients with epilepsy are doing worse.

We recommended add-on treatment with lamotrigine and increased dosage step-by-step to 200 mg daily. In case of further seizures, the dosage may be further increased, some patients take up to 800 mg daily without any side effects. In this constellation, the patient has a chance for becoming seizure free of 20-30 %. If further seizures occur with levetiracetam and lamotrigin in high dosages, the patient’s epilepsy is by definition pharmacoresistant. The patient then needs work-up for epilepsy surgery with intensified video-EEG long-term monitoring.

We initiated new neuroimaging with 3 Tesla MRI following a specific epilepsy protocol. In 3 months, the patient presents again in our specialized epilepsy outpatient clinic.

Cases of the months before