Classification of Epilepsy

Abstract

A 20-year-old, right-handed, white female had drug-resistant epilepsy. She had failed several AEDs as single agents due to tolerability issues and had been maintained on Phenytoin for years. She was born via an uncomplicated delivery and was without any known risk factors for epilepsy. Seizure onset began at 9 years of age, manifesting as “petit mal” seizures. These occurred weekly and were worse after menarche. She was initially given Ethosuximide after an EEG demonstrated “petit mal seizure discharges,” though she had incomplete improvement in her episodic staring spells. Subsequently, “grand mal” seizures developed within the year following puberty, and she was changed to valproate. She continued with intermittent “petit mal” seizures on a weekly basis. Trials of AEDs included VPA, Dilantin, and Ethosuximide were ineffective. TPM and LEV lead to side-effects of “memory problems” and severe anxiety. When she was seen for another opinion regarding pregnancy and driving, she was taking PHT 400 mg PO qHS which had provided her the best control thus far. Her neurological examination was normal. A CT of the brain was normal. A high resolution brain MRI with an epilepsy protocol was performed (Fig. 17.1). A computer-assisted ambulatory EEG demonstrated a staring spells associated with 2 Hz generalized spike-and-waves with normal background electrocerebral activity.