Monthly Case

A currently 57-year-old female patient suffered first generalized tonic clonic epileptic seizures from wakefulness in her 26th year of life. Partial onset of seizures was not reported. Multiple EEGs and neuroimaging (CT and MRI scans) were normal, the cause of epilepsy remained unclear. In summary, this patient suffers from undetermined epilepsy as the available information does not allow to make the allocation to either a generalized or to a partial epilepsy syndrome.

Initially, the patient was treated with valproic acid, but she gained more than 10 kg of weight. Therefore, treatment was switched to carbamazepine, which was stopped after a couple of years due to unspecific side effects. For the last 15 years, the patient has been treated with lamotrigine, the current daily dose is 2 x 100 mg. The patient feels fine, she does not report any side effects.

As the patient is seizure free for more than 25 years, we discussed with her the possibility to taper and finally withdraw lamotrigine. Her prognosis regarding ongoing seizure freedom is favorable, as EEGs and neuroimaging have always been normal and as she became seizure free with the first antiepileptic drug. The medication has been changed in the meanwhile due to side effects not due to lack of efficacy.

However, the patient refused to stop antiepileptic treatment. The former seizures have been traumatizing and she admits to be afraid of seizure recurrence after lamotrigine withdrawal. Furthermore, she does not have any side effects with this substance.

We can understand this patient’s perspective and do not see any medical problem with continuation of the current lamotrigine treatment regimen.

Cases of the months before