Posted: September 4th, 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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An important risk factor that might have contributed to LS’s epilepsy is her history of febrile convulsion in childhood. Febrile convulsions are seizures that occur in young children, usually as a result of a high fever. Having a history of febrile convulsions increases the risk of developing epilepsy later in life.

Since the initial workup reveals normal electrolytes, normal blood glucose level, and negative urine toxicology screening, further diagnostic studies should be obtained to understand the risk of recurrent unprovoked seizures. The following studies would be appropriate:

Magnetic Resonance Imaging (MRI) of the brain: This can help identify any structural abnormalities or lesions in the brain that may be causing the seizures.
Computed Tomography (CT) scan of the head: This can also help identify any structural abnormalities, such as tumors or bleeding, that may be related to the seizures.
Complete blood count (CBC): This can help identify any underlying infection or inflammation that may be triggering the seizures.
Lumbar puncture: If there is suspicion of infection or inflammation involving the central nervous system, a lumbar puncture may be performed to analyze the cerebrospinal fluid.
Genetic testing: In some cases, genetic testing may be considered to identify any underlying genetic causes of epilepsy.
Since the EEG shows epileptiform discharges over the right temporal head region, the best next course of action in terms of antiseizure therapy would be to initiate targeted antiseizure medication. The choice of medication would depend on the specific epilepsy syndrome and the patient’s individual characteristics. However, common antiseizure medications that may be considered for temporal lobe epilepsy include carbamazepine, oxcarbazepine, and lamotrigine. The selection of the medication should be made by a qualified healthcare professional based on a thorough evaluation of the patient’s condition.

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