Abstracts

 Results: The patient remains seizure free to date while on LEV. CSF analysis revealed a mild elevated protein level. Paraneoplastic panel was negative. Initial MRI revealed abnormal fluid-attenuated inversion recovery (FLAIR) signal hyperintensity within the bilateral insula and mesial temporal lobes without enhancement, left worse than right. These abnormalities resolved by the third MRI study. The brain PET was unremarkable. The initial EEG revealed focal slowing in left temporal region. The repeat EEGs revealed independent left and right temporal focal slowing as well as left temporal sharp waves. Conclusions: Seizures were not a reported adverse effect in the clinical trials prior to FDA approval of Boostrix?(R). However, in the post-marketing surveillance, several neurological complications following immunization were reported including Guillain?"Barr頳yndrome, Bell's palsy, seizure, demyelinating diseases, and encephalopathy/encephalitis. Interestingly some of the patients had a history of anti-convulsive treatment, EEG abnormalities, and seizures prior to vaccination. The clinical history preceding the seizure along with EEG findings supports a diagnosis of temporal lobe epilepsy (TLE). Although it is possible that the seizures following the vaccination was only a coincidental temporal association, the development of focal encephalitis and clinical seizures shortly after the vaccination and improvement in the MRI signal abnormality over time are highly suggestive of a direct consequence of the vaccination. This phenomenon would support the theory that TLE may have an underlying neuro-inflammatory pathogenesis. Further studies are needed to substantiate this theory. This has important implications in the management of TLE and the potential role of immunomodulation therapies. Funding: None