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Posted: January 18th, 2023
WEEK 3- PHARM Epilepsy
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.
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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
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• Uncle with alcohol-associated withdrawal seizures
Labs
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• 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?
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An important risk factor that might have contributed to LS's epilepsy is her history of a febrile convulsion in childhood following pneumonia at the age of 10. Febrile seizures are the most common type of seizures in childhood, and while most children who experience them do not develop epilepsy, there is an increased risk of developing epilepsy in those who have had a febrile seizure.
Initial workup reveals normal electrolytes, normal blood glucose level, and negative urine toxicology screening. Additional diagnostic studies that should be obtained to further understand the risk of recurrent unprovoked seizures include an MRI of the brain to evaluate for structural abnormalities or lesions, and an EEG to evaluate for abnormal electrical activity in the brain. An Ambulatory EEG or a Video-EEG may be also obtained to capture the seizures if these are rare.
An EEG obtained shows epileptiform discharges over the right temporal head region, which suggests that LS has temporal lobe epilepsy. The best next course of action in terms of antiseizure therapy would be to start her on an appropriate antiepileptic medication, such as carbamazepine or lamotrigine. The choice of the specific medication will depend on the type of seizures and the patient's medical history. The medication should be titrated to the minimum effective dose and the patient should be monitored for side effects and efficacy. In addition, the patient should be referred to an Epileptologist for further evaluation, as surgery may be considered in some cases of temporal lobe epilepsy.
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