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Case 284.

Matthew Klumpp1, Rajiv Mangla1, Atin Goel1

  • 1From the Department of Diagnostic Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210-2306.

Radiology
|July 21, 2020
PubMed
Summary
This summary is machine-generated.

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This case study details a 36-year-old woman with medically refractory epilepsy experiencing complex partial seizures. Despite antiepileptic drug compliance, her seizures persisted, necessitating further investigation.

Area of Science:

  • Neurology
  • Radiology
  • Epilepsy Research

Background:

  • A 36-year-old woman with a history of developmental delay and medically refractory epilepsy since birth presented with persistent simple and complex partial seizures.
  • Seizures were associated with postictal migraines and breakthrough events despite adherence to antiepileptic drug regimens.
  • Previous electroencephalography in 2010 revealed focal subclinical status with left parietal-occipital spike-and-wave discharges.

Purpose of the Study:

  • To document the clinical presentation and neuroimaging findings in a patient with long-standing, medically refractory epilepsy.
  • To compare current unenhanced neuroimaging with prior gadolinium-enhanced MRI to assess for changes over time.
  • To highlight the challenges in managing intractable epilepsy and the role of serial neuroimaging.

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Main Methods:

  • Review of a single patient's medical history, including seizure semiology and treatment regimens.
  • Analysis of electroencephalography (EEG) findings, including ambulatory EEG.
  • Comparison of recent unenhanced head CT and brain MRI with a historical gadolinium-enhanced brain MRI from approximately 9 years prior.

Main Results:

  • The patient experienced continuous simple partial seizures and breakthrough complex partial seizures with postictal migraines.
  • Despite multiple antiepileptic drug regimens, complex partial seizures occurred every 2-3 months.
  • Unenhanced imaging was performed due to increased seizure activity, with comparison made to a previous enhanced MRI.

Conclusions:

  • This case underscores the chronic and refractory nature of certain epilepsy syndromes.
  • Serial neuroimaging plays a role in evaluating patients with intractable epilepsy, even when contrast is unavailable for recent studies.
  • Further investigation may be warranted to understand the underlying etiology and optimize management strategies for such complex cases.