Posted: May 30th, 2023

LS is a 31-year-old woman who presents after a first-time seizure

LS is a 31-year-old woman who presents after a first-time seizure. The patient recalls experiencing an unusual rising sensation in the abdomen accompanied by an unpleasant, brief, metallic taste before losing awareness. Bystanders observed her to develop leftward head turning followed by stiffening and rhythmic jerking of her limbs. She appeared disoriented for 15 minutes following the event but steadily recovered to baseline functioning.
Past Medical History
Febrile convulsion in childhood following pneumonia at the age of 10
No birth-related or developmental complications Medications
Fluoxetine, 40 mg once daily Family History
Uncle with alcohol-associated withdrawal seizures
Labs
Electrolytes: Normal
Blood glucose level: Normal
Urine toxicology screening: Negative
Discussion Questions
1. What is an important risk factor that might have contributed to LS’s epilepsy?
2. Initial workup reveals normal electrolytes, normal blood glucose level, and negative urine toxicology screening. Which diagnostic studies should be obtained to further understand the risk of recurrent unprovoked seizures?
3. An EEG is obtained and shows epileptiform discharges over the right temporal head region. What is the best next course of action in terms of antiseizure therapy?3 apa citations

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An important risk factor that might have contributed to LS’s epilepsy is her history of febrile convulsion in childhood. Febrile seizures, which occur in the setting of fever, are a known risk factor for the development of epilepsy later in life. Although febrile seizures are generally considered benign, they can be associated with an increased risk of developing epilepsy, especially if they are complex (lasting longer than 15 minutes, focal in nature, or recurrent).

Given the presentation of a first-time seizure, further diagnostic studies should be obtained to understand the risk of recurrent unprovoked seizures. The recommended diagnostic studies include:

a. Electroencephalogram (EEG): An EEG can help identify abnormal electrical activity in the brain that may be indicative of epilepsy. It can also provide information about the location and type of epileptic discharges.

b. Brain imaging (MRI or CT scan): Imaging studies of the brain can help identify any structural abnormalities, such as tumors, vascular malformations, or scar tissue, that may be causing the seizures.

In the case where an EEG shows epileptiform discharges over the right temporal head region, the best next course of action in terms of antiseizure therapy would be to start a medication that is effective against temporal lobe epilepsy. The specific choice of antiseizure medication would depend on various factors, including the patient’s overall health, potential side effects, and any contraindications. However, common first-line medications for temporal lobe epilepsy include carbamazepine, oxcarbazepine, and lamotrigine.

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