A Patient Whose Epilepsy Diagnosis Changed Three Times Over 20 Years

Publisher Summary This chapter inspects the case of a patient diagnosed with frontal lobe epilepsy with focal motor seizures, occasionally secondarily generalized, and absence-like seizures. A 42-year-old, right-handed housewife had a cerebral contusion from a fall at the age of 4 years. At the age of 18 years, she experienced her first seizure, with loss of consciousness followed by a convulsion. Subsequently, she repeatedly had seizures consisting of right-sided hemifacial spasms and slight turning of the head and eyes toward the right; these seizures occurred several times a day. At 19 years of age, short bursts of bisynchronous spike-and-wave or polyspike-andwave activity slightly slower than 3 Hz were observed. Coincident with the generalized and diffuse spike-and-wave discharges was a brief arrest of motion, which was documented by video-EEG monitoring. Phenytoin, carbamazepine, and valproate, often in combination, were administered at maximal dosage with insufficient control of seizures. The seizures occurred on a daily to weekly basis. The patient underwent a left frontal resection at the age of 41. Scar tissue was found at surgery in the antero-inferior portion of the left frontal lobe. Seizures subsided for 6 months, but then simple and complex focal seizures recurred, although they were obviously less frequent and not as disabling as before. The diagnosis of this patient during more than 20 years of follow-up has changed twice, with three different diagnoses—idiopathic generalized epilepsy with absences, symptomatic generalized epilepsy with atypical absences, and frontal lobe epilepsy with simple and complex focal seizures. This patient showed that secondary bilateral synchrony might be associated with ictal phenomena that mimic absences.