A 63 year old right-handed male with treated hypertension, diabetes, and hyperlipidemia presented to the emergency department after experiencing a witnessed “grand mal” seizure. CT disclosed a right frontal mass. He was administered Levetiracetam (LEV) 1000 mg IV. Neurology evaluation revealed a new left hemiparesis. Upon arrival to the NICU he was mildly somnolent. An EEG was obtained after arrival to the NICU and revealed the following;
The EEG demonstrated periodic lateralized epileptiform discharges (PLEDs) maximal at the right frontal-central electrode derivations (black arrows). The tracing reflects the interictal-ictal continuum of right frontal PLEDs with left eye movements (blue arrows) from a focal seizure. Continuous EEG monitoring is helpful in identifying unrecognized seizures when mental status remains impaired after a seizure.
LEV was a good choice in this case due to its’ favorable pharmacokinetics, concurrent conditions and their treatments due to a lack of drug-drug interactions. Structural lesions often predict a high risk for seizure recurrence as well as a poor response to treatment. He received additional LEV and recovered without incident.
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