Case summary: Kate

After an uneventful birth and normal early milestones, Kate presented with infantile spasms at the age of seven months. Seizures terminated within two days of initiation of ACTH but her subsequent development was delayed. At two-and-a-half years of age she developed complex partial seizures that responded to carbamazepine monotherapy. The dosage was increased when she developed generalized tonic-clonic seizures and she is currently maintained on a maximal dose of a controlled release formulation. The EEG strongly supports the clinical diagnosis of complex partial seizures and an MRI shows a classical neuronal migration defect with gross band heterotopia throughout both cerebral hemispheres. She attends a school for children with moderate learning difficulties.