Adnan Al-Khuraibet, MD, DSc

A 9 yrs old girl with history of single nocturnal generalized and right partial seizures at age of 3 yrs, controlled on Depakine. She was seizure-free for about 2 yrs. Depakine was discontinued gradually. Then started again in 2006 to get right partial seizures again for brief period (minutes) about once every 1-2 months at awakening from sleep. Depekane restarted with good control but noticed to gain weight (now 43 Kg), so stopped and replaced by Tegretol, but again stopped due to rash. Currently from March 2007 Lamictal started, now 125 mg bd. Noticed to have worsening of the attacks on increasing dose of Lamictal; more frequent (1-2 per week), longer duration (30-60 min.) and associated with a form of posturing of the right hand (sort of fist) for about 30 minutes. No LOC. Attacks always at awakening with pain in the calf area.

EEG several times always abnormal with left focal sharp activity (frontotemporal region), 2 attacks were seen during ambulatory 38 hours long-term EEG recording. MRI reported normal. Her school performance is getting affected because of these attacks; socially the girl is well adjusted at home and good student. We thought these are unusual partial seizures which needs further adjustment of treatment/modification or most likely Lamictal-induced movements or Lamictal-aggravated seizures. The plan to stop Lamictal and replace it by either LEV or TPM anticonvulsant. 

Video of the patient (requires real player) 

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(c) 2007 M.H.Rivner

Date Modified 12/7/2007