Puzzling Cases of Epilepsy

Preface to the second edition

List of Contributors

Part I Diagnostic Puzzles and Uncertainties


1. A Young Woman with Mouth Jerking Provoked by Reading


2. Two Adult Patients with Infantile Spasms


3. An Infant with Partial Seizures and Infantile Spasms


4. Epilepsia Partialis Continua versus Non-Epileptic Seizures


5. Panic Attacks in a Woman with Frontal Lobe Epilepsy


6. Frequent Night Terrors


7. Genetic (Generalized) Epilepsy with Febrile Seizures Plus


8. A Visit to the Borderland of Neurology and Psychiatry


9. A Case of Complex Partial Status Epilepticus


10. Late-Onset Myoclonic Seizures in Down’s Syndrome


11. Fainting, Fear, and Pallor in a 22-Month-Old Girl

Part II Intriguing Causes and Circumstances


12. Hyperactive Behavior and Attentional Deficit in a 7-Year-Old Boy with Myoclonic Jerks


13. Temporal Lobe Epilepsy, Loss of Episodic Memory, and Depression in a 32-Year-Old Woman


14. Epileptic “ Dreamy States ” in a Young Man


15. Nocturnal Seizures in a Man with Coronary Disease


16. Non-convulsive Status Epilepticus and Frontal Lobe Seizures in a Patient with a Chromosome Abnormality


17. An Unusual Cause of Nocturnal Attacks


18. Myoclonic Jerks in a Computer Specialist


19. Their Previous Physicians had Told Them that They Should not Become Pregnant Because They have Epilepsy


20. Status Epilepticus after a Long Day of White-Water Rafting in the Grand Canyon


21. A Farmer Who Watched His Own Seizures


22. The Borderland of Neurology and Cardiology


23. A Man with Shoulder Twitching


24. The Girl with Visual Seizures Who wasn’t Seeing Things – Transient Blindness in a Young Girl


25. A Young Man with Noise-Induced Partial Seizures


26. Non-convulsive Status Epilepticus in a Patient with Idiopathic Generalized Epilepsy


27. Pseudohypoglycemia Manifesting as Complex Partial Seizures in a Patient with Type III Glycogen Storage Disease

Part III Surprising Turns and Twists


28. Recurrent Amnestic Episodes in a 62-Year-Old Diabetic Patient


29. Attacks of Nausea and Palpitations in a Woman with Epilepsy


30. Absence Status Epilepticus in a 60-Year-Old Woman


31. Hemiplegia in a 76-Year-Old Woman with Status Epilepticus


32. Persistence Pays Off


33. Drugs Did Not Work in a Little Girl with Absence Seizures


34. “ Alternative ” Therapy for Partial Epilepsy – with a Twist


35. A 19-Year-Old Man with Epilepsy, Aphasia, and Hemangioma of the Cranial Vault


36. Severe Psychiatric Disorder in an 8-Year-Old Boy with Myoclonic–Astatic Seizures


37. A Girl with Two Epilepsy Syndromes


38. The Obvious Cause of Seizures May Not Be the Underlying Cause


39. Absence Seizures in an Adult


40. A Case Solved by Seizures During Sleep


41. Alternative Psychosis in an Adolescent Girl?


42. Exacerbation of Seizures in a Young Woman


43. Genetic Counseling in a Woman with a Family History of Refractory Myoclonic Epilepsy


44. “ Funny Jerks ” Run in the Family


45. Side Effects That Imitate Seizures


46. Epilepsy, Migraine, and Cerebral Calcifi cations


47. An Unusual Application of Epilepsy Surgery


48. All is Not What it Seems


49. A Patient Whose Epilepsy Diagnosis Changed Three Times Over 20 Years


50. If You Don’t Succeed, Investigate


51. Should He or Shouldn’t He? Is It Reasonable to Prescribe Carbamazepine after Lamotrigineinduced Stevens–Johnson Syndrome?


52. The Value of Repeating Video–EEG Monitoring and the Importance of Concomitant ECG Tracings in the Evaluation of Changes in Seizure Semiology

PART IV Unforeseen Complications and Problems


53. A 35-Year-Old Man with Poor Surgical Outcome after Temporal Lobe Surgery


54. When More is Less


55. Change of Antiepileptic Drug Treatment for Fear of Side Effects in a 45-Year-Old Seizure-Free Patient


56. Personality and Mood Changes in a Teenager


57. Monitoring Patients May Be More Important Than Their Laboratory Tests


58 Depression in a Student with Juvenile Myoclonic Epilepsy


59. Osteomalacia in a Patient Treated with Multiple Anticonvulsants


60. Parkinsonism and Cognitive Decline in a 64-Year-Old Woman with Epilepsy


61. Problems in Managing Epilepsy during and after Pregnancy


62. Status Epilepticus in a Heavy Snorer


63. A Boy with Epilepsy and Allergic Rhinitis


64. Seizures and Behavior Disturbance in a Boy


65. Abulia in a Seizure-Free Patient with Frontal Lobe Epilepsy


66. The Continuing Place of Phenobarbital


67. A Patient with Epilepsy Slips Down Some Attic Stairs


68. Bilateral Hip Fractures in a 43-Year-Old Woman with Epilepsy


69. Picking a Wrong Antiepileptic Drug for a 9-Year-Old Girl


70. With Epilepsy You Never Know

Part V Unexpected Solutions


71. When Antiepileptic Drugs Fail in an Infant with Seizures, Consider Vitamin B6


72. A 12-Year-Old Boy with Daily Clonic Seizures


73. A Child with Attention-Defi cit Disorder, Autistic Features and Frequent Epileptiform EEG Discharges


74. Complete Seizure Control in a 14-Year-Old Boy after Temporal Lobectomy Failed


75. Ictal Crying in a 32-Year-Old Woman


76. Healing Begins with Communicating the Diagnosis


77. An Unusual Case of Seizures and Violence


78. Attacks of Generalized Shaking without Postictal Confusion


79. Lennox–Gastaut Syndrome with Good Outcome Associated with Perisylvian Polymicrogyria


80. Temporal Lobe Resection in a Patient with Severe Psychiatric Problems


81. An Open Mind Can Benefi t the Patient


82. An Unexpected Lesson


83. When Surgery Is Not Possible, All Hope Is Not Lost


84. Sometimes Less Is More


85. Unexpected Benefit from an Old Antiepileptic Drug


86. Status Epilepticus Responsive to Intravenous Immunoglobulin


87. Surgical Success in a Patient with Diffuse Brain Trauma


88. Dietary Treatment of Seizures from a Hypothalamic Hamartoma


89. Can the Behavioral and Cognitive Effects of AEDs Be Predicted?


90. A Child with So-Called Nocturnal Paroxysmal Dystonia Whose Epilepsy Arose from Orbital Cortex


91. The Night Mom Didn’t Come Back


92. The EEG – Not the EEG Report – Makes the Difference

Part VI Where Clinical Knowledge and Preclinical Science Meet


93. The Double-Hit Hypothesis: Is It Clinically Relevant?

Comment: The Double-Hit Hypothesis: Is It Clinically Relevant?


94. Atypical Evolution in a Case of Benign Childhood Epilepsy with Centrotemporal Spikes

Comment 1: Does Kindling in Humans Occur? Comments Based on the Previous Case Study

Comment 2: Does Kindling in Humans Occur?

Comments Based on the Previous Case from a Preclinical Perspective


95. Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Patient with Recurrent Status Epilepticus as the Single Manifestation of Her Epilepsy

Comment 1: Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Preclinical Perspective

Comment 2: Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Clinical Perspective


96. Why Do Some Patients Seem to Develop Tolerance to AEDs? Development of Antiepileptic Drug Tolerance in a Patient with Temporal Lobe Epilepsy

Comment 1: Why Do Some Patients Seem to Develop Tolerance to AEDs? A Preclinical Discussion

Comment 2: How Can We Detect the Development of Tolerance (Loss of Effect) to AEDs in Patients with Epilepsy? A Clinical Discussion


97. Why Is There a Similar Ceiling Effect for the Efficacy of Most If Not All Antiepileptic Drugs in Adult Epilepsy? Reaching the Ceiling or Hitting the Wall?

Comment 1: Why Is There a Similar Ceiling Effect for the Effi cacy of Most If Not All Antiepileptic Drugs in Adult Epilepsy? A Clinical Perspective

Comment 2: What Clinical Observations on the Epidemiology of Antiepileptic Drug Intractability Tell Us About the Mechanisms of Pharmacoresistance


98. Difficult-to-Treat Idiopathic Generalized Epilepsy in a Young Woman

Comment 1: Can We Predict a Drug’s Efficacy in a Specifi c Epilepsy Syndrome? A Preclinical Discussion

Comment 2: Bridging the Gap between Evidence-Based Medicine and Clinical Practice


99. Psychogenic Non-Epileptic Seizures “ Redux ”

Comment 1: Is There a Neurobiological Basis to Stress-induced, Non-epileptic Behaviors that Mimic Seizures?

Comment 2: Evidence for a Neurobiological Basis for Non-epileptic Seizures


100. Why Does VNS Take So Long to Work?

Comment 1: Commentary: Why Does VNS Take So Long to Work?


101. If at First You Don’t Succeed

Comment 1: Why Antiepileptic Drugs Fail in Some Patients: A Preclinical Perspective

Comment 2: The Continuing Conundrum of Reversible Drug-resistant Epilepsy: A Clinical Perspective


102. Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not?

Comment 1: Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not? A Comment on the Evidence

Comment 2: Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not? A Clinical Perspective

Index