Antiepileptics
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Lack of efficacy: case report A 12-year-old girl exhibited a lack of efficacy during antiepileptic treatment with carbamazepine, clobazam, lacosamide, oxcarbazepine and sodium valproate for frontal lobe epilepsy [routes not stated]. The right-handed girl, who had normal birth and development, presented with seizures. She had seizures since one and a half years of age. She developed focal impaired awareness seizures accompanied by focal to bilateral tonic-clonic seizures, along with secondary generalisation. Her seizure frequency was 1–2 episodes per month. No family history of seizures or febrile seizures was reported. Currently, she had been receiving antiepileptic treatment with lacosamide 250 mg/day, clobazam 15 mg/day and carbamazepine 600 mg/day. Previously, she had received oxcarbazepine 900 mg/day and sodium valproate 800 mg/day. At the current presentation, the neurological examination showed normal results. In view of pre-surgical evaluation, neuropsychological testing was performed, which indicated frontoparietal deficits. Because of drug resistance epilepsy, video electroencephalography was performed, which showed the right frontal interictal epileptiform discharges. Additionally, multiple seizures of ictal onset and right frontal semiology were noted. An MRI showed deep right superior frontal sulcus with the blurred grey-white junction. Also, the presence of white matter changes raised the possibility of right frontal dysplasia. A positron emission tomography (PET) scan showed right frontal hypometabolism. Due to clinico-electro-radiological concordance, the girl underwent electrocorticography-guided resection of frontal dysplastic. Post-resection, MRI revealed no residual dysplasia. At follow-up (at one year), she remained seizure-free and was receiving carbamazepine 400 mg/day. Histopathological examination confirmed the diagnosis of frontal lobe epilepsy associated with focal neuronal lipofuscinosis. Mhatre R, et al. Frontal lobe epilepsy with focal neuronal lipofuscinosis - Case report of a rare entity. Epilepsy and Behavior Reports 14: 2020. Available from: URL: http:// 803497636 doi.org/10.1016/j.ebr.2020.100369
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Reactions 22 Aug 2020 No. 1818
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