ABSTRACT
We present a woman with epilepsy secondary to a lesion in the left frontal lobe. She developed episodes of disorientation and behavioral changes. She was taking valproic acid (1500 mg/day), topiramate (200 mg/day), and phenobarbital (100 mg/day). During an episode, the EEG revealed moderate encephalopathy and ammonia levels were increased (195 µg/dL, reference range: 11-60 µg/dL). Episodes ceased after withdrawal of valproic acid.
Subject(s)
Fructose/analogs & derivatives , Hyperammonemia/chemically induced , Neurotoxicity Syndromes/diagnosis , Phenobarbital/adverse effects , Valproic Acid/adverse effects , Drug Synergism , Drug Therapy, Combination , Epilepsy/drug therapy , Female , Fructose/adverse effects , Fructose/therapeutic use , Humans , Hyperammonemia/diagnosis , Middle Aged , Phenobarbital/therapeutic use , Topiramate , Valproic Acid/therapeutic useABSTRACT
BACKGROUND: On most occasions, the diagnosis of seizures and epilepsy is considered in cases of temporary disturbance of neurologic function. In this clinical situation, the physician in charge (neurologist, emergency physician, general practitioner, intensivist, cardiologist, psychiatrist, etc.) should establish the differential diagnosis with other pathologies that can also cause transient neurologic disturbances. REVIEW SUMMARY: We will review the relevant literature about the diagnostic process and the differential diagnosis of epileptic seizures and epilepsy at the onset of the disease, and the medical consequences of an incorrect diagnosis. CONCLUSION: Neurologists and non-neurologists often diagnose epilepsy. The diagnostic challenge consists of correctly interpreting the medical history, characteristics of the episodes and physical and neurologic examination, and properly using and interpreting supplemental paraclinical tests.
Subject(s)
Diagnosis, Differential , Diagnostic Errors , Epilepsy/diagnosis , Epilepsy/classification , Epilepsy/physiopathology , HumansABSTRACT
Las crisis epilépticas se acompañan a menudo de cambios en el ritmo cardíaco. Habitualmente son pasajeras y no relevantes para la sintomatología del paciente, recuperando en segundos o pocos minutos el ritmo basal habitual. En este trabajo presentamos un caso clínico en que una paciente con una epilepsia previamente conocida sufría además episodios de sensación de mareo e inestabilidad, a modo de presíncope. El estudio de vídeo-electroencefalográfico sirvió para registrar uno de estos episodios, demostrándose una crisis epiléptica focal asociada a asistolia: la crisis era puramente electroencefalográfica, subclínica, y la sintomatología típica apareció durante la asistolia que seguía después de 40 s a los cambios electroencefalográficos. La recuperación fue rápida, pero para el manejo futuro la indicación de un marcapasos debe ser valorada
Frequently, epileptic seizures are accompanied by changes in the heart rate. They are ussually transient and irrelevant for the patients symptoms and the patient recorders his usually baseline rhythm in second or a few minutes. In this report we present a case of a patient diagnosed previously of epilepsy who presented episodes of dizziness and presyncope. During the video-EEG study we recorded one of these spells. The diagnosis of this spell was a focal seizure associated with asystole: the seizure was almost asymptomatic, and only when the asystole developed (40 seconds after the EEG ictal changes) the patient complained about dizziness. Recovery was fast, but treatment with pacemaker must be considered
