George Lee Morris Ill
The patient is a 41-year-old woman who developed seizures in her early teens. Her seizures consisted of premonitory sensations for a day before the events and an aura of language difficulties - she understood that speech was occurring but could not determine what was being said to her. Episodes of loss of consciousness with or without preceding auras occurred several times a month. Auras without subsequent loss of consciousness occurred rarely.
Her past medical history included minor surgeries, two uneventful pregnancies with normal children, and the occasional treatment of depression with tricyclic antidepressants. There was no history of head trauma, febrile seizures or previous hospitalization. Prior medications included divalproex, phenytoin, felbamate, gabapentin and lamotrigine. Each was unsuccessful in stopping her seizures and several had significant cognitive effects.
She used low-estrogen oral contraceptives and daily multivitamins. She was married with two children of elementary-school age, and she had worked as a nurse before her second child. She did not drink alcohol or smoke tobacco. Her health was currently good and she reported a positive mood. Her current medication for seizures was carbamazepine 1400 mg/day in three divided doses.
The patient's general appearance, physical examination and neurological examination were normal.
She had a routine EEG that showed left mid-temporal spike-and slow-wave discharges and intermittent slowing in the left temporal lobe. Cranial magnetic imaging resonance scanning was normal and showed symmetric hippocampal structures.
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