On presentation in 1996 the patient was receiving valproate 2250 mg/day, carbamaze-pine 1800 mg/day, and clonazepam 10 mg/day. His therapy was slowly changed to oxcar-bazepine 1600mg/day and valproate 2000 mg/day. He lost 10 kg of excess weight and developed insomnia. He went into absence status epilepticus, vomiting profusely. Doses were changed to oxcarbazepine 1800 mg/day and valproate 1500 mg/day. In late 1997 he was having absences every few days. His drug regimen was changed to lamotrigine 150 mg/day and valproate 1000 mg/day.
Over the past 4 years, the patient has become a relatively docile and happy young man. He likes traveling by plane, riding cars, and playing, but he does not sleep continuously for more than 4 h. He enjoys his family and understands most of what happens. Some of his noises have become objective. His swallowing problem ended in late 1998, allowing him to take tablets regularly and to eat everything. His seizures stopped in early 1999. His only word is Mae, which is the word for Mum in Portuguese.
A thorough search of the literature and consultation with two expert neurosurgeons, including an uncle of the patient, as well as Dr. Fred Andermann of Montreal, did not reveal any relationship between the bone malformation and the patient's epilepsy or aphasia. After the follow-up MRI scan showed that the lesion had not changed, everybody decided to leave it alone.
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