Case Study

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;

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How can EEG help after a seizure?

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.

References

  1. Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004;62:1743-1748.
Authored By: 
William O. Tatum DO
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Authored Date: 
10/2010