Attacks of Nausea and Palpitations in a Woman with Epilepsy

Publisher Summary This chapter inspects the case of a woman suffering from idiopathic generalized epilepsy with some features of juvenile myoclonic epilepsy. Her seizures had begun when she was 12 years with generalized tonic–clonic seizures and, allegedly, psychomotor seizures that were not further described. Seizures usually occurred just after awakening. Video-EEG recording showed innumerable generalized bursts of 4–6 Hz spike–polyspike-waves, each burst lasting 1–2 seconds and accompanied by a slight lapse of consciousness and upward deviation of the eyes with blinking, but no clonic movements in the extremities. She was initially treated with carbamazepine and then with phenytoin, but treatment was changed to valproate because of side effects and insufficient seizure control. Valproate was reasonably effective, but because of unacceptable weight gain, her treatment was changed to a combination of lamotrigine and vigabatrin. After the video-EEG, valproate was re-instituted, and ethosuximide was subsequently added, with much improved seizure control. Because of recurrent problems with weight gain, valproate was replaced by lamotrigine. This patient's aura-like phenomena with strong autonomic components had obviously been misinterpreted as evidence of focal seizures. Furthermore, several normal EEGs despite prolonged monitoring made a diagnosis of idiopathic generalized epilepsy less likely, until a rather short but intensive session of video-EEG monitoring together with the history led to the correct classification of her seizure types and epilepsy syndrome.