Epilepsy is one of the most common neurological disorders, and original observations in the field are often the key to diagnosis and successful treatment. Physicians new to the field as well as seasoned practitioners will benefit from more than one hundred case vignettes that explore the universe of epilepsy as it presents in daily practice. Some of these cases challenge long-held views about epilepsy and others bring the reader to the limits of our understanding of epilepsy, both in clinical and basic science. To improve the interface of clinical and basic science in epilepsy, basic scientists comment on the potential mechanisms underlying clinical observations, and clinicians assess the potential impact of recent results of experiments in the laboratory. Puzzling Cases of Epilepsy highlights the importance that original observations have in inspiring both new treatments and continued research.
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Table of Contents
Preface to the second editionList of Contributors
Part I Diagnostic Puzzles and Uncertainties
1. A Young Woman with Mouth Jerking Provoked by Reading
2. Two Adult Patients with Infantile Spasms
3. An Infant with Partial Seizures and Infantile Spasms
4. Epilepsia Partialis Continua versus Non-Epileptic Seizures
5. Panic Attacks in a Woman with Frontal Lobe Epilepsy
6. Frequent Night Terrors
7. Genetic (Generalized) Epilepsy with Febrile Seizures Plus
8. A Visit to the Borderland of Neurology and Psychiatry
9. A Case of Complex Partial Status Epilepticus
10. Late-Onset Myoclonic Seizures in Down's Syndrome
11. Fainting, Fear, and Pallor in a 22-Month-Old Girl
Part II Intriguing Causes and Circumstances
12. Hyperactive Behavior and Attentional Deficit in a 7-Year-Old Boy with Myoclonic Jerks
13. Temporal Lobe Epilepsy, Loss of Episodic Memory, and Depression in a 32-Year-Old Woman
14. Epileptic " Dreamy States � in a Young Man
15. Nocturnal Seizures in a Man with Coronary Disease
16. Non-convulsive Status Epilepticus and Frontal Lobe Seizures in a Patient with a Chromosome Abnormality
17. An Unusual Cause of Nocturnal Attacks
18. Myoclonic Jerks in a Computer Specialist
19. Their Previous Physicians had Told Them that They Should not Become Pregnant Because They have Epilepsy
20. Status Epilepticus after a Long Day of White-Water Rafting in the Grand Canyon
21. A Farmer Who Watched His Own Seizures
22. The Borderland of Neurology and Cardiology
23. A Man with Shoulder Twitching
24. The Girl with Visual Seizures Who wasn't Seeing Things Transient Blindness in a Young Girl
25. A Young Man with Noise-Induced Partial Seizures
26. Non-convulsive Status Epilepticus in a Patient with Idiopathic Generalized Epilepsy
27. Pseudohypoglycemia Manifesting as Complex Partial Seizures in a Patient with Type III Glycogen Storage Disease
Part III Surprising Turns and Twists
28. Recurrent Amnestic Episodes in a 62-Year-Old Diabetic Patient
29. Attacks of Nausea and Palpitations in a Woman with Epilepsy
30. Absence Status Epilepticus in a 60-Year-Old Woman
31. Hemiplegia in a 76-Year-Old Woman with Status Epilepticus
32. Persistence Pays Off
33. Drugs Did Not Work in a Little Girl with Absence Seizures
34. " Alternative � Therapy for Partial Epilepsy with a Twist
35. A 19-Year-Old Man with Epilepsy, Aphasia, and Hemangioma of the Cranial Vault
36. Severe Psychiatric Disorder in an 8-Year-Old Boy with Myoclonic-Astatic Seizures
37. A Girl with Two Epilepsy Syndromes
38. The Obvious Cause of Seizures May Not Be the Underlying Cause
39. Absence Seizures in an Adult
40. A Case Solved by Seizures During Sleep
41. Alternative Psychosis in an Adolescent Girl?
42. Exacerbation of Seizures in a Young Woman
43. Genetic Counseling in a Woman with a Family History of Refractory Myoclonic Epilepsy
44. " Funny Jerks � Run in the Family
45. Side Effects That Imitate Seizures
46. Epilepsy, Migraine, and Cerebral Calcifi cations
47. An Unusual Application of Epilepsy Surgery
48. All is Not What it Seems
49. A Patient Whose Epilepsy Diagnosis Changed Three Times Over 20 Years
50. If You Don't Succeed, Investigate
51. Should He or Shouldn't He? Is It Reasonable to Prescribe Carbamazepine after Lamotrigineinduced Stevens-Johnson Syndrome?
52. The Value of Repeating Video-EEG Monitoring and the Importance of Concomitant ECG Tracings in the Evaluation of Changes in Seizure Semiology
PART IV Unforeseen Complications and Problems
53. A 35-Year-Old Man with Poor Surgical Outcome after Temporal Lobe Surgery
54. When More is Less
55. Change of Antiepileptic Drug Treatment for Fear of Side Effects in a 45-Year-Old Seizure-Free Patient
56. Personality and Mood Changes in a Teenager
57. Monitoring Patients May Be More Important Than Their Laboratory Tests
58 Depression in a Student with Juvenile Myoclonic Epilepsy
59. Osteomalacia in a Patient Treated with Multiple Anticonvulsants
60. Parkinsonism and Cognitive Decline in a 64-Year-Old Woman with Epilepsy
61. Problems in Managing Epilepsy during and after Pregnancy
62. Status Epilepticus in a Heavy Snorer
63. A Boy with Epilepsy and Allergic Rhinitis
64. Seizures and Behavior Disturbance in a Boy
65. Abulia in a Seizure-Free Patient with Frontal Lobe Epilepsy
66. The Continuing Place of Phenobarbital
67. A Patient with Epilepsy Slips Down Some Attic Stairs
68. Bilateral Hip Fractures in a 43-Year-Old Woman with Epilepsy
69. Picking a Wrong Antiepileptic Drug for a 9-Year-Old Girl
70. With Epilepsy You Never Know
Part V Unexpected Solutions
71. When Antiepileptic Drugs Fail in an Infant with Seizures, Consider Vitamin B6
72. A 12-Year-Old Boy with Daily Clonic Seizures
73. A Child with Attention-Defi cit Disorder, Autistic Features and Frequent Epileptiform EEG Discharges
74. Complete Seizure Control in a 14-Year-Old Boy after Temporal Lobectomy Failed
75. Ictal Crying in a 32-Year-Old Woman
76. Healing Begins with Communicating the Diagnosis
77. An Unusual Case of Seizures and Violence
78. Attacks of Generalized Shaking without Postictal Confusion
79. Lennox-Gastaut Syndrome with Good Outcome Associated with Perisylvian Polymicrogyria
80. Temporal Lobe Resection in a Patient with Severe Psychiatric Problems
81. An Open Mind Can Benefi t the Patient
82. An Unexpected Lesson
83. When Surgery Is Not Possible, All Hope Is Not Lost
84. Sometimes Less Is More
85. Unexpected Benefit from an Old Antiepileptic Drug
86. Status Epilepticus Responsive to Intravenous Immunoglobulin
87. Surgical Success in a Patient with Diffuse Brain Trauma
88. Dietary Treatment of Seizures from a Hypothalamic Hamartoma
89. Can the Behavioral and Cognitive Effects of AEDs Be Predicted?
90. A Child with So-Called Nocturnal Paroxysmal Dystonia Whose Epilepsy Arose from Orbital Cortex
91. The Night Mom Didn't Come Back
92. The EEG Not the EEG Report Makes the Difference
Part VI Where Clinical Knowledge and Preclinical Science Meet
93. The Double-Hit Hypothesis: Is It Clinically Relevant?
Comment: The Double-Hit Hypothesis: Is It Clinically Relevant?
94. Atypical Evolution in a Case of Benign Childhood Epilepsy with Centrotemporal Spikes
Comment 1: Does Kindling in Humans Occur? Comments Based on the Previous Case Study
Comment 2: Does Kindling in Humans Occur?
Comments Based on the Previous Case from a Preclinical Perspective
95. Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Patient with Recurrent Status Epilepticus as the Single Manifestation of Her Epilepsy
Comment 1: Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Preclinical Perspective
Comment 2: Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Clinical Perspective
96. Why Do Some Patients Seem to Develop Tolerance to AEDs? Development of Antiepileptic Drug Tolerance in a Patient with Temporal Lobe Epilepsy
Comment 1: Why Do Some Patients Seem to Develop Tolerance to AEDs? A Preclinical Discussion
Comment 2: How Can We Detect the Development of Tolerance (Loss of Effect) to AEDs in Patients with Epilepsy? A Clinical Discussion
97. Why Is There a Similar Ceiling Effect for the Efficacy of Most If Not All Antiepileptic Drugs in Adult Epilepsy? Reaching the Ceiling or Hitting the Wall?
Comment 1: Why Is There a Similar Ceiling Effect for the Effi cacy of Most If Not All Antiepileptic Drugs in Adult Epilepsy? A Clinical Perspective
Comment 2: What Clinical Observations on the Epidemiology of Antiepileptic Drug Intractability Tell Us About the Mechanisms of Pharmacoresistance
98. Difficult-to-Treat Idiopathic Generalized Epilepsy in a Young Woman
Comment 1: Can We Predict a Drug's Efficacy in a Specifi c Epilepsy Syndrome? A Preclinical Discussion
Comment 2: Bridging the Gap between Evidence-Based Medicine and Clinical Practice
99. Psychogenic Non-Epileptic Seizures " Redux �
Comment 1: Is There a Neurobiological Basis to Stress-induced, Non-epileptic Behaviors that Mimic Seizures?
Comment 2: Evidence for a Neurobiological Basis for Non-epileptic Seizures
100. Why Does VNS Take So Long to Work?
Comment 1: Commentary: Why Does VNS Take So Long to Work?
101. If at First You Don't Succeed
Comment 1: Why Antiepileptic Drugs Fail in Some Patients: A Preclinical Perspective
Comment 2: The Continuing Conundrum of Reversible Drug-resistant Epilepsy: A Clinical Perspective
102. Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not?
Comment 1: Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not? A Comment on the Evidence
Comment 2: Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not? A Clinical Perspective
Index
