Epilepsy & Treatment

Abstract:

Patient in early 30s with refractory, left temporal lobe epilepsy in a setting of left hippocampal sclerosis. Increase in seizure severity and freqency over 25 years, with worsening depression. Patient working in corporate environment.

Aim:

To decrease frequency and/or severity of seizures; increase quality of life and life expectancy

Treatment:

Likely Cause of Epilepsy:

• Lengthy febrile seizure aged 6months

Past AEDs tried:

• Sodium Valproate, Levetiracetam, Phenytoin

AED side effects experienced:

• Memory function decrease, fatigue, numbness (phenytoin), mood instability (Levetiracetam)

Seizure triggers:

• Sleep deprevation, anxiety, forgetting AEDs

Further Diagnosis Related to Epilepsy/AEDs

Surgery Exploration Testing:

• Video Telemetry
• EEG
• fMRI
• Psychological evalutation/neuropsychology assessment inc IQ
• Full understanding of surgery risks and potential outcomes by patient

Surgical Procedure:

• Left Temporal Lobectomy, Feb 2013
• CSF leak followed, leading to suture of the wound

Post-operative Diagnoses Included:

• Severe depression, extreme problems with memory, and exhaustion (for 6-12months)
• Blind spot in right eye
• 5 tonic-clonic seizures post surgery, last in November 2017
• Irregular complex partial seizures (average 4/5 per year)

Current Drugs:

• Levothyroxine 50mg QD
• Lamotrigine 100mg BD
• Lacosamide 100mg BD
• Venlafaxine 150 BD
• Clobazam 10mg

Conclusion:

Status: outcome Engel class 2

Patient has experienced significant decrease in number and severity of seizures. Along with psychological therapy, patient’s quality of life is greatly improved. Despite continued taking of AEDs, and infrequent seizures, the results of surgery is considered to be a success by patient. Patient has greater focus, continues to travel and has supportive partner and friends.