Epilepsy

A progressive and severe rash

Picture Quiz - Answers, Volume 20, Issue 4, Pages 249 – 308 (2021)

A 73-year-old female patient with epilepsy presented to hospital with a progressive, diffuse macular rash over the trunk and limbs with associated mucosal blistering and discharge. Ocular symptoms initially predominated and she was treated for presumed bacterial conjunctivitis by her General Practitioner the previous day. On the acute medical unit supportive management was initiated for suspected adverse drug reaction (ADR) to a recent lamotrigine dose increase. Skin biopsy confirmed a diagnosis of toxic epidermal necrolysis. We present this case to highlight the importance of medication history taking and raise awareness of indolent presentations of life-threatening ADRs. Caution should be applied following dose changes to anti-epileptics, even if previously stable.

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Pause for thought? Syncope and sinus arrest as the presenting feature of temporal lobe epilepsy

Case Reports, Volume 13, Issue 2, Pages 53 - 100 (2014)

Abstract

Some forms of focal epilepsy, including temporal lobe epilepsy, are rarely associated with ictal bradycardia and sinus node arrest. We report a case of a previously healthy man presenting with syncope in whom telemetry revealed sinus arrest. Initial treatment was with permanent pacemaker implantation and it was only following a subsequent grand mal seizure that other symptoms suggestive of temporal lobe epilepsy were documented. Anti-epileptic medication was subsequently commenced with resolution of all symptoms. There are few previously reported cases of syncope and documented sinus node arrest as the presenting feature of temporal lobe epilepsy.

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Acute management and investigation of seizures

Clinical Reviews, Volume 4, Issue 3, Pages 81 - 112 (2005)

Abstract

This article summarises the management of different situations in which patients present to the acute medical service with seizures. It covers the management of single attacks of loss of consciousness, multiple seizures and status epilepticus in patients with and without known epilepsy. The importance of a good history and witness account where there is a diagnostic issue is stressed. In the case of multiple seizures and status epilepticus, the investigation of the cause of the attacks as well as their acute management is reviewed.

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