Rationale:
Approximately 20% to 30% of patients with epilepsy (PWE) are not aware when they have seizures, particularly when they occur during sleep. Failure to recognize the different seizure types has significant negative impact on the patients’ epilepsy management, comorbid disorders and quality of life. . We present a case report of a patient with rare generalized tonic-clonic seizures that had been treated with levetiracetam and lamotrigine, which was complicated by a mood disorder attributed to levetiracetam and frequent reported nocturnal arousals interpreted as a symptoms of her depression.
Methods:
Not applicable.
Results:
The patient was a 31 years-old woman with a 20 year history of GTC seizures occurring with a frequency of 2 to 3 year, both in awake and sleep states. She reported frequent nocturnal arousals often several in one night. She underwent a continuous video EEG (cvEEG) which showed frequent mesiofrontal spike and slow waves. She experienced up to ten nocturnal arousals over the five-day study with several events per night with a stereotyped semiology consisting of tonic flexion of her left upper extremity, followed by tonic extension with asynchronous bilateral leg movements. The entire event had a duration of 30 seconds, and she was not aware of any of the motor phenomena. Electrographically her arousals were associated with high amplitude rhythmic theta activity. These events were diagnosed as focal unaware seizures and her pharmacologic regimen was changed to a polytherapy regimen of lamotrigine and valproic acid.
Conclusions:
This patient illustrates the failure to identify frequent nocturnal focal seizures with impaired awareness that had gone unrecognized for several years and which had been attributed to a comorbid mood disorder.
Funding:
No funding was received in support of this abstract.