PMC7726346_01
Patient's drawing depicting seizure semiology. Numbers placed in the image depict the order of symptoms: (1) flashing colors in the lower right visual field, (2) prosopagnosia, (3) visual disturbance of hand tearing in half, and (4) hair invading people's faces, fear. Isolated events that did not appear in an orderly fashion: *reading words with incapacity to interpret them; **eye version to the right.
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F1
These always occurred in a stepwise manner, and the patient drew her seizures (Figure 1).
Timeline of clinical manifestations and treatment schemes. Summary of chronological findings in the patient's clinical manifestations: initial right optic neuritis 1 year prior the onset of epilepsy, followed by epilepsy onset and 1 month later appearance of chronic non-progressive recurrent epilepsia partialis continua, as described in Figure 1. These seizures could persist up to a week in duration, with fluctuating visual auras as described in detail in text. Antiseizure medications given in different time periods are also shown. Escitalopram was given at year 1 when he patient was presumed to have psychogenic non-epileptic seizures, with persistent seizures. On year 2, patient came to our Institute with epilepsia partialis continua; diagnosis workup and treatment were started. She achieved seizure freedom 3 months later.
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F2
These episodes appeared intermittently during the day, lasting for brief seconds, but the patient constantly experienced them, which could also be present in her sleep appearing as dreams with the same manifestations (see Figure 2).
Coregistered PET/MRI study, depicting focally increased metabolic uptake in the right occipital lobe involving the lateral gyri with extension to cuneus and lingual gyri. No contralateral uptake was found or any other foci or abnormal metabolic uptake in the brain or whole body.
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F3
A full-body positron emission tomography (PET) scan showed no systemic associated tumor but a right occipital area of impressive hypermetabolism, presumed to be ictal (Figure 3).
Electroencephalogram (EEG) with focal status epilepticus and after administration of antiseizure drug (AD). (A) Ictal surface EEG with generalized slowing predominantly in the right temporo-occipital regions, with ictal monomorphic activity in the right occipital regions, with 10 clinical events of focal motor seizures without impairment of consciousness. (B) Surface EEG after administration of 200 mg Brivaracetam (BRV), with resolution of ictal activity, showing focal slowing in the temporo-occipital right region.
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F4
ASD treatment combinations. A dose of 200 mg IV brivaracetam (BRV) was administered followed by immediate clinical and EEG resolution (Figure 4).