Case history

A 61-year-old woman had long-standing epilepsy since age 19. The most frequent seizure episodes were characterised by vacancy lasting seconds. She also had episodes involving perception of a strange feeling and lip smacking followed by tonic spasm of hands. Her average seizure frequency was 5–8 per month (93/year; range 83–142/year). Her husband had kept a meticulous record of her seizure frequency for the last 24 years (figure 1).

Electroencephalography showed temporal involvement and CT brain scan did not show any focal lesion. MRI performed with an epilepsy protocol did not show any evidence of mesial temporal sclerosis. She took different antiepileptic drugs (AED) as monotherapy or combination treatment without much success. The latest prescribed combination was lamotrogine 400 mg (twice daily), topiramate 400 mg (twice daily) and gabapentin 1200 mg (three times daily).

She also has multiple sclerosis diagnosed at age 48, based on sensory symptoms, presence of multiple T2 high signal lesions in periventricular, supraventricular and subcortical areas in bilateral temporal and occipital lobes on MRI and presence of unmatched oligoclonal bands in cerebrospinal fluid. She had one relapse 3 years after symptom onset and required …