Posted: June 14th, 2023

LS is a 31-year-old woman who presents after a first-time seizure

LS is a 31-year-old woman who presents after a first-time seizure. The patient recalls experiencing an unusual rising sensation in the abdomen accompanied by an unpleasant, brief, metallic taste before losing awareness. Bystanders observed her to develop leftward head turning followed by stiffening and rhythmic jerking of her limbs. She appeared disoriented for 15 minutes following the event but steadily recovered to baseline functioning.
Past Medical History
Febrile convulsion in childhood following pneumonia at the age of 10
No birth-related or developmental complications Medications
Fluoxetine, 40 mg once daily Family History
Uncle with alcohol-associated withdrawal seizures
Labs
Electrolytes: Normal
Blood glucose level: Normal
Urine toxicology screening: Negative
Discussion Questions
1. What is an important risk factor that might have contributed to LS’s epilepsy?
2. Initial workup reveals normal electrolytes, normal blood glucose level, and negative urine toxicology screening. Which diagnostic studies should be obtained to further understand the risk of recurrent unprovoked seizures?
3. An EEG is obtained and shows epileptiform discharges over the right temporal head region. What is the best next course of action in terms of antiseizure therapy?2 apacitations

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One important risk factor that might have contributed to LS's epilepsy is her history of febrile convulsion in childhood. Febrile seizures are a common cause of seizures in children and can increase the risk of developing epilepsy later in life.
In order to further understand the risk of recurrent unprovoked seizures, LS should undergo an MRI of the brain to evaluate for any structural abnormalities or lesions that may be causing the seizures. Additionally, a prolonged EEG (24-48 hours) may be necessary to capture any abnormal electrical activity in the brain that may not be seen on a routine EEG.
Based on the EEG findings of epileptiform discharges over the right temporal head region, the best next course of action in terms of antiseizure therapy would be to start LS on a medication that is effective for temporal lobe epilepsy, such as carbamazepine or oxcarbazepine. However, the choice of medication should be individualized based on LS's medical history, comorbidities, and potential side effects. It is important to closely monitor LS's response to the medication and adjust the dosage as needed to achieve seizure control while minimizing side effects.

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