Monthly Case

“New” seizures after epilepsy surgery | 12-2015

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A 36-year-old male patient suffers from partial epilepsy since his 8th year of life after – at the age of 5 years – he had fallen out of the window resulting in severe traumatic brain injury. Cranial MRI revealed a widespread lesion in the left temporal lobe which also involved frontal lobe structures. Seizure semiology was stereotypical with tonic posturing of the right upper extremity followed by cloni. Frequency was 4 to 5 per month. Following invasive long-term video-EEG with subdural grid electrodes, the seizure focus at the posterior margin of the lesion could be indentified and was resected. Six month after the operation, the patient reported two seizures; he was quite frustrated as the felt the resection to be in vain. On detailed history taking, he said that he had motor signs involving the whole body; this would correspond to tonic clonic generalized seizures. As increase in seizure severity after epilepsy surgery at least was unexpected, we took third party history by a colleague of the patient. She reported that the patient was lying on the floor with jerks of his upper und lower extremities for 2 to 3 min. Motor signs were fluctuating, eyes were closed, and after the end of motor signs the patient was immediately completely reoriented. This description clearly argues for psychogenic non-epileptic seizures.

New-onset psychogenic non-epileptic seizures manifesting after successful epilepsy surgery have recently been described in 4% of patients. Risk factors were female sex and pre-existing psychiatric disturbances.

We explained to the above reported patient our diagnostic appraisal and conveyed within a couple of days a first appointment at our new outpatient clinic for psychogenic non-epileptic seizures, which is part of the Epilespy-Center Berlin-Brandenburg.

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