Complex epilepsy: its all in the history

CLINICAL CASECurrent presentation

The patient is right-handed, in early 50s and carries the diagnoses of generalised tonic-clonic seizures, spastic quadriparesis and severe learning disability. Generalised tonic-clonic seizures, the only reported seizure type, occur every few weeks. Current antiseizure drugs include valproate, clonazepam, levetiracetam and lacosamide. Both the patient’s condition and treatment have changed little over the past 11 years for which electronic records are available in the clinic. At best, the patient mobilises with aids and communicates through simple gestures with very limited understanding. The patient attends the clinic with elderly mother and two carers.

Would you try to review the syndromic diagnosis or try to establish a cause?

Guidelines advocate classifying a person’s seizure and epilepsy types, the epilepsy syndrome as well as the underlying cause.1 Reviewing the diagnosis is particularly important when seizures are treatment-resistant.2

From this perspective, the patient’s history of intellectual disability may be…

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