Monthly Case

A 73-year-old male otherwise healthy patient suffered in April 2017 from a first unprovoked tonic clonic generalized seizure. Brain MRI as well as routine and sleep EEG were normal. Thus, this seizure is classified as isolated unprovoked epileptic seizure without significantly increased risk for seizure recurrence. In this constellation, the regular intake of an antiepileptic drug is not recommended.

But the current patient was deeply concerned to suffer a next seizure and asked for an antiepiletic drug. We accepted his request and administered the well-tolerated and efficacious compound lamotrigine in a low dose of 100 mg daily. We informed the patient that – follwing the guidelines for isolated unprovoked seizures – he has to refrain to drive a car on his own for the next 6 months.

At follow-up in October 2017, the patient reported that he increasingly had developed dizziness with lamotrigine which had impaired his quality of life. Therefore, 3 days before the appointment, he had decided on his own to withdraw lamotrigine. On his presentation, dizziness has ceased.

We again informed the patient on the low risk for seizure recurrence in his particular situation. The patient agreed – after the negative experience with lamotrigine – to refrain from taking another antiepileptic drug.

The 6-months driving ban was scheduled to be lifted in October 2017. But we had to inform the patient that after withdrawal of the antiepileptic, he will not be allowed to drive a car on his own for another 3 months.

In summary, after a first unprovoked epileptic seizure with normal EEG- and MRI-examinations, there is no indication for the regular intake of an antiepileptic drug.

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