Epilepsia farmacorresistente en un paciente con oligodendroglioma frontal y antecedentes de encefalitis varicelosa

INTRODUCTION: Drug-resistant epilepsy is considered when two tolerated antiepileptic drugs trials, appropriately chosen and adequately employed have failed, to achieve a sustained absence of seizures. This situation is more significant in patients with focal onset seizures and in seizures due to acquired causes. CLINICAL CASE: A male who was hospitalized at five years old for a clinical profile of fever, cephalea, vomiting, instability to the gait and difficulty standing, after suffering from a varicella rash seven days ago. Varicella zoster virus IgM was positive in serum. He was diagnosed with acute varicella encephalitis, and the evolution was favorable with an acyclovir treatment. Given this medical history, the patient began suffering from seizures at fourteen and a half years old. He was treated with several antiepileptics, for one and a half years until it was concluded that the epilepsy was drug-resistant. A cerebral MRI showed a 17 mm in diameter hyperintense lesion, irregular in shape, at the level of the right parasagittal frontal cortico-subcortical region, and was reported as compatible with varicella zoster residual glyosis. Since the patient was still having seizures, he was considered as a candidate for epilepsy surgery. The video electroencephalogram showed recruiting rhythms, which seemed to originate in the right frontal region. The lesionectomy was performed, and the anatomopathological piece was reported as NOS oligodendroglioma. At present, and after one-year post surgery, the patient has been seizures free and is following a discontinuous pattern of antiepileptic treatment. CONCLUSION: The cause of the epilepsy was diagnosed in this patient, at first, with regard to the history of varicella zoster virus encephalitis, which can produce seizures as a consequence. Nevertheless in epilepsy, from clinical data, an electroencephalogram, a cerebral MRI and evolution, it must always make a differential diagnosis with other causes, among them long term evolution neoplasm.