1. How would you classify this patient’s seizure disorder?
Simple partial seizures (SPS) with autonomic symptoms, manifested by an epigastric sensation (i.e., an abdominal aura) and tachycardia. Also, occasional SPS with experiential symptoms (déjà vu).
Complex partial seizures (CPS), manifested by staring with impaired awareness and responsiveness, plus automatisms (lip smacking, eyelid blinking, picking).
2. Is there anything in the description of the seizures that indicates a precise localization of the onset of the seizures?
Yes. Most of her SPS symptoms and CPS signs are characteristic of seizures beginning in the medial temporal region.
3. Is there anything in the description of the patient’s seizures that indicates which side of the brain the seizures arise from?
No. Most autonomic and experiential SPS (auras) are localizing but not lateralizing.
4. Is there anything in the patient’s history that suggests a possible etiology or pathologic process involved in her seizure disorder? If so, what clinical-pathologic entity (i.e., epileptic syndrome) may be the cause of this patient’s seizures?
Yes. Approximately 40 to 70% of patients with refractory hippocampal sclerosis (HS), the most common cause of temporal lobe epilepsy (TLE), have a history of prolonged or multiple febrile convulsions, or other initial precipitating injuries (IPIs) (e.g., meningitis, encephalitis, head trauma, birth injury), between the ages of six months and six years. Her seizure history is suggestive of medically intractable medial temporal lobe epilepsy (MTLE) due to HS.
5. What diagnostic procedure(s) would you undertake at this point?
References:
1. Watson C. Expert Rev Neurotherapeutics 2003;3:821-828. (This is a review article with many additional references included.)
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