Case summary: Benjamin

Benjamin was diagnosed with Aspberger's syndrome on starting school. Prior to that, at the age of five years he presented with seizures involving deviation of the head and eyes to the right and jerking of the limbs. EEG was very abnormal with multifocal paroxysmal activity and occasional bursts of spike and slow wave activity. CT scan and MRI were normal and investigations failed to identify any underlying aetiology for the seizures. Carbamazepine was initially successful in controlling the seizures but improvement was not sustained despite maximal tolerated doses. A similar course of events was seen with sodium valproate, initially in combination with ethosuximide (for emergent tonic-clonic and absence seizures), then with vigabatrin (which unmasked myoclonic seizures), clonazepam and finally lamotrigine. The EEG remained abnormal even during periods of improved seizure control and there was no improvement in his Aspberger's syndrome. His epilepsy syndrome has not been classified. Subsequent treatment options include lamotrigine monotherapy.