Epileptic encephalopatis: is it avoidable?

Case presentation: Female, 8 years old, with onset of seizures at 2 months, evolving with refractory epilepsy. The seizures were characterized by behavioral arrest and vacant gaze, in addition to episodes of loss of tone and head turn to the right with intense salivation. Patient has used topiramate, nitrazepam, carbamazepine and valproate. On examination, he is moderately mentally retarded and does not speak. Prolonged videoelectroencephalogram demonstrated focal seizures in the right cerebral hemisphere and resonance image showed right frontal cortical dysplasia associated with right occipital heterotopic nodule. Surgery was performed with intraoperative monitoring. After complete resection of the lesion and the initial epileptiform discharges, a greater extension of the epileptiform pattern was observed, which became more diffuse with each resection extension. At follow up patient persisted with seizures with only a discrete frequency reduction.

Discussion: Epilepsies in childhood have several causes, including genetic and structural ones, emphasizing the importance of overlapping etiologies. Encephalopathy, characterized by diffuse brain dysfunction, should be considered even in patients with predefined lesions, as it is an important cause of epileptic seizures.

Final comments: The case in question shows persistence of epileptiform paroxysms even with resection of the lesion and the initial epileptiform discharges. This finding may be related to the epileptic encephalopathy that patients with early onset epilepsies present. Although it is not possible to absolutely affirm, earlier surgery could have avoided this pattern of secondary epileptogenesis.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023