Frontal lobe epilepsy

A 28-year-old female patient suffered from frontal lobe epilepsy. She first experienced a focal to bilateral tonic-clonic seizure at 14, followed by a similar event at 18. MRI was performed after the first seizure revealing bilateral subependymal periventricular heterotopia, a neuronal migration disorder notoriously resulting in DRE in most cases. There was also an impression of a mild degree of cortical dysplasia in the insular cortex on both sides, slightly more prominent on the left side. At 19, she experienced 4–5 focal to bilateral tonic-clonic seizures per week. After being treated with various combinations of ASMs, the frequency of generalized seizures was reduced to 1 per year for the following three years. By the age of 23, the generalized seizures were well controlled by medication. Still, she continued to experience daily focal seizures (1–3 times per day) characterized by episodes of a sudden onset of fear of impending doom associated with tachycardia and sweating, followed by a “strange” sensation in the right face spreading to the right hemitongue, occasionally accompanied by right-hand numbness, lasting for less maximally 30 s without any loss of consciousness.