Puzzling Cases of Epilepsy

Puzzling Cases of Epilepsy

2nd Edition - September 4, 2008

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  • Editors: Dieter Schmidt, Steven Schachter
  • eBook ISBN: 9780080559544
  • Paperback ISBN: 9780123740052

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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. Puzzling Cases of Epilepsy highlights the importance that original observations have in inspiring both new treatments and continued research.

Key Features

  • Presents unique and challenging case vignettes in epilepsy contributed by eminent physicians in the field
  • Provides practicing physicians with examples of how baffling cases were handled and solved
  • A new section provides a translational perspective, with basic scientists discussing the potential mechanisms underlying original clinical observations, and clinical scientists discussing the clinical implications of experiments in the epilepsy laboratory


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

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


Product details

  • No. of pages: 544
  • Language: English
  • Copyright: © Academic Press 2008
  • Published: September 4, 2008
  • Imprint: Academic Press
  • eBook ISBN: 9780080559544
  • Paperback ISBN: 9780123740052

About the Editors

Dieter Schmidt

Affiliations and Expertise

Epilepsy Research Group, Berlin

Steven Schachter

Affiliations and Expertise

Professor of Neurology, Harvard Medical School, Chief Academic Officer, CIMIT

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