Puzzling Cases of Epilepsy

Edited by

  • Dieter Schmidt, Epilepsy Research Group, Berlin
  • Steven C. Schachter, MD, Harvard Medical School, Boston, MA, USA

Epilepsy is one of the most common neurological disorders, and original observations in the field are often the key to diagnosis and successful treatment. Physicians new to the field as well as seasoned practitioners will benefit from more than one hundred case vignettes that explore the universe of epilepsy as it presents in daily practice. Some of these cases challenge long-held views about epilepsy and others bring the reader to the limits of our understanding of epilepsy, both in clinical and basic science. To improve the interface of clinical and basic science in epilepsy, basic scientists comment on the potential mechanisms underlying clinical observations, and clinicians assess the potential impact of recent results of experiments in the laboratory. This book highlights the importance that original observations have in inspiring both new treatments and continued research.
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Audience

Basis scientists in epilepsy who are interested in the current clincial challenges; Physicians (Neurologists, Psychiatrists, Neuropediatricians) entering the field of epilepsy; experienced Physicians who want to learn how experts handle their cases and what lessons they learn from their patients

 

Book information

  • Published: September 2008
  • Imprint: ACADEMIC PRESS
  • ISBN: 978-0-12-374005-2


Table of Contents


Preface to the second edition

List of Contributors

Part I Diagnostic Puzzles and Uncertainties

1. A Young Woman with Mouth Jerking Provoked by Reading

2. Two Adult Patients with Infantile Spasms

3. An Infant with Partial Seizures and Infantile Spasms

4. Epilepsia Partialis Continua versus Non-Epileptic Seizures

5. Panic Attacks in a Woman with Frontal Lobe Epilepsy

6. Frequent Night Terrors

7. Genetic (Generalized) Epilepsy with Febrile Seizures Plus

8. A Visit to the Borderland of Neurology and Psychiatry

9. A Case of Complex Partial Status Epilepticus

10. Late-Onset Myoclonic Seizures in Down’s Syndrome

11. Fainting, Fear, and Pallor in a 22-Month-Old Girl

Part II Intriguing Causes and Circumstances

12. Hyperactive Behavior and Attentional Deficit in a 7-Year-Old Boy with Myoclonic Jerks

13. Temporal Lobe Epilepsy, Loss of Episodic Memory, and Depression in a 32-Year-Old Woman

14. Epileptic “ Dreamy States ” in a Young Man

15. Nocturnal Seizures in a Man with Coronary Disease

16. Non-convulsive Status Epilepticus and Frontal Lobe Seizures in a Patient with a Chromosome Abnormality

17. An Unusual Cause of Nocturnal Attacks

18. Myoclonic Jerks in a Computer Specialist

19. Their Previous Physicians had Told Them that They Should not Become Pregnant Because They have Epilepsy

20. Status Epilepticus after a Long Day of White-Water Rafting in the Grand Canyon

21. A Farmer Who Watched His Own Seizures

22. The Borderland of Neurology and Cardiology

23. A Man with Shoulder Twitching

24. The Girl with Visual Seizures Who wasn’t Seeing Things - Transient Blindness in a Young Girl

25. A Young Man with Noise-Induced Partial Seizures

26. Non-convulsive Status Epilepticus in a Patient with Idiopathic Generalized Epilepsy

27. Pseudohypoglycemia Manifesting as Complex Partial Seizures in a Patient with Type III Glycogen Storage Disease

Part III Surprising Turns and Twists

28. Recurrent Amnestic Episodes in a 62-Year-Old Diabetic Patient

29. Attacks of Nausea and Palpitations in a Woman with Epilepsy

30. Absence Status Epilepticus in a 60-Year-Old Woman

31. Hemiplegia in a 76-Year-Old Woman with Status Epilepticus

32. Persistence Pays Off

33. Drugs Did Not Work in a Little Girl with Absence Seizures

34. “ Alternative ” Therapy for Partial Epilepsy - with a Twist

35. A 19-Year-Old Man with Epilepsy, Aphasia, and Hemangioma of the Cranial Vault

36. Severe Psychiatric Disorder in an 8-Year-Old Boy with Myoclonic-Astatic Seizures

37. A Girl with Two Epilepsy Syndromes

38. The Obvious Cause of Seizures May Not Be the Underlying Cause

39. Absence Seizures in an Adult

40. A Case Solved by Seizures During Sleep

41. Alternative Psychosis in an Adolescent Girl?

42. Exacerbation of Seizures in a Young Woman

43. Genetic Counseling in a Woman with a Family History of Refractory Myoclonic Epilepsy

44. “ Funny Jerks ” Run in the Family

45. Side Effects That Imitate Seizures

46. Epilepsy, Migraine, and Cerebral Calcifi cations

47. An Unusual Application of Epilepsy Surgery

48. All is Not What it Seems

49. A Patient Whose Epilepsy Diagnosis Changed Three Times Over 20 Years

50. If You Don’t Succeed, Investigate

51. Should He or Shouldn’t He? Is It Reasonable to Prescribe Carbamazepine after Lamotrigineinduced Stevens-Johnson Syndrome?

52. The Value of Repeating Video-EEG Monitoring and the Importance of Concomitant ECG Tracings in the Evaluation of Changes in Seizure Semiology

PART IV Unforeseen Complications and Problems

53. A 35-Year-Old Man with Poor Surgical Outcome after Temporal Lobe Surgery

54. When More is Less

55. Change of Antiepileptic Drug Treatment for Fear of Side Effects in a 45-Year-Old Seizure-Free Patient

56. Personality and Mood Changes in a Teenager

57. Monitoring Patients May Be More Important Than Their Laboratory Tests

58 Depression in a Student with Juvenile Myoclonic Epilepsy

59. Osteomalacia in a Patient Treated with Multiple Anticonvulsants

60. Parkinsonism and Cognitive Decline in a 64-Year-Old Woman with Epilepsy

61. Problems in Managing Epilepsy during and after Pregnancy

62. Status Epilepticus in a Heavy Snorer

63. A Boy with Epilepsy and Allergic Rhinitis

64. Seizures and Behavior Disturbance in a Boy

65. Abulia in a Seizure-Free Patient with Frontal Lobe Epilepsy

66. The Continuing Place of Phenobarbital

67. A Patient with Epilepsy Slips Down Some Attic Stairs

68. Bilateral Hip Fractures in a 43-Year-Old Woman with Epilepsy

69. Picking a Wrong Antiepileptic Drug for a 9-Year-Old Girl

70. With Epilepsy You Never Know

Part V Unexpected Solutions

71. When Antiepileptic Drugs Fail in an Infant with Seizures, Consider Vitamin B6

72. A 12-Year-Old Boy with Daily Clonic Seizures

73. A Child with Attention-Defi cit Disorder, Autistic Features and Frequent Epileptiform EEG Discharges

74. Complete Seizure Control in a 14-Year-Old Boy after Temporal Lobectomy Failed

75. Ictal Crying in a 32-Year-Old Woman

76. Healing Begins with Communicating the Diagnosis

77. An Unusual Case of Seizures and Violence

78. Attacks of Generalized Shaking without Postictal Confusion

79. Lennox-Gastaut Syndrome with Good Outcome Associated with Perisylvian Polymicrogyria

80. Temporal Lobe Resection in a Patient with Severe Psychiatric Problems

81. An Open Mind Can Benefi t the Patient

82. An Unexpected Lesson

83. When Surgery Is Not Possible, All Hope Is Not Lost

84. Sometimes Less Is More

85. Unexpected Benefit from an Old Antiepileptic Drug

86. Status Epilepticus Responsive to Intravenous Immunoglobulin

87. Surgical Success in a Patient with Diffuse Brain Trauma

88. Dietary Treatment of Seizures from a Hypothalamic Hamartoma

89. Can the Behavioral and Cognitive Effects of AEDs Be Predicted?

90. A Child with So-Called Nocturnal Paroxysmal Dystonia Whose Epilepsy Arose from Orbital Cortex

91. The Night Mom Didn’t Come Back

92. The EEG - Not the EEG Report - Makes the Difference

Part VI Where Clinical Knowledge and Preclinical Science Meet

93. The Double-Hit Hypothesis: Is It Clinically Relevant?

Comment: The Double-Hit Hypothesis: Is It Clinically Relevant?

94. Atypical Evolution in a Case of Benign Childhood Epilepsy with Centrotemporal Spikes

Comment 1: Does Kindling in Humans Occur? Comments Based on the Previous Case Study

Comment 2: Does Kindling in Humans Occur?

Comments Based on the Previous Case from a Preclinical Perspective

95. Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Patient with Recurrent Status Epilepticus as the Single Manifestation of Her Epilepsy

Comment 1: Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Preclinical Perspective

Comment 2: Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Clinical Perspective

96. Why Do Some Patients Seem to Develop Tolerance to AEDs? Development of Antiepileptic Drug Tolerance in a Patient with Temporal Lobe Epilepsy

Comment 1: Why Do Some Patients Seem to Develop Tolerance to AEDs? A Preclinical Discussion

Comment 2: How Can We Detect the Development of Tolerance (Loss of Effect) to AEDs in Patients with Epilepsy? A Clinical Discussion

97. Why Is There a Similar Ceiling Effect for the Efficacy of Most If Not All Antiepileptic Drugs in Adult Epilepsy? Reaching the Ceiling or Hitting the Wall?

Comment 1: Why Is There a Similar Ceiling Effect for the Effi cacy of Most If Not All Antiepileptic Drugs in Adult Epilepsy? A Clinical Perspective

Comment 2: What Clinical Observations on the Epidemiology of Antiepileptic Drug Intractability Tell Us About the Mechanisms of Pharmacoresistance

98. Difficult-to-Treat Idiopathic Generalized Epilepsy in a Young Woman

Comment 1: Can We Predict a Drug’s Efficacy in a Specifi c Epilepsy Syndrome? A Preclinical Discussion

Comment 2: Bridging the Gap between Evidence-Based Medicine and Clinical Practice

99. Psychogenic Non-Epileptic Seizures “ Redux ”

Comment 1: Is There a Neurobiological Basis to Stress-induced, Non-epileptic Behaviors that Mimic Seizures?

Comment 2: Evidence for a Neurobiological Basis for Non-epileptic Seizures

100. Why Does VNS Take So Long to Work?

Comment 1: Commentary: Why Does VNS Take So Long to Work?

101. If at First You Don’t Succeed

Comment 1: Why Antiepileptic Drugs Fail in Some Patients: A Preclinical Perspective

Comment 2: The Continuing Conundrum of Reversible Drug-resistant Epilepsy: A Clinical Perspective

102. Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not?

Comment 1: Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not? A Comment on the Evidence

Comment 2: Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not? A Clinical Perspective

Index