Abstract

This case demonstrates two uncommon conditions presenting in a single patient. A 47-year-old male with a history since childhood of generalised tonic clonic seizures, well controlled, not on anti epileptic medication for 6 years presented with frequent complex partial seizures, disorientation and deteriorating short term memory. EEG was normal however, serial MRI showed static cystic change in the left temporal lobe—suggestive of a dysembryoplastic neuroepithelial tumour. Seizures were treated initially with levetiracetam and subsequently with clobazam but remained problematic. Anti voltage gated potassium channel antibodies were subsequently found to be raised, initially 193 but subsequently 573. He was treated with intravenous corticosteroids with improvement in both working memory and seizure frequency. Due to the prevalence of these two rare conditions, this case raises the possibility of a link between dysembryoplastic neuroepithelial tumours and anti voltage gated potassium channel antibody associated encephalopathy. It also demonstrates two conditions that are individually difficult to treat resulting in a therapeutic challenge for this one combined presentation.