Temporal Lobe Epilepsy

Violent

Step 1: View clinicals

A 29 year old man presents following an episode of altered behaviour for 15 minutes, where he was uncharacteristically violent. He did not lose consciousness at any point. He cannot recollect the episode, but remembers experiencing a feeling of intense and indefinable pleasure immediately beforehand. The episode was observed by his wife, who additionally noticed abnormal movements of his right hand. This is his first such episode, and his medical history is completely unremarkable. He is not on any medications, denies substance abuse and only consumes alcohol socially.


Step 2: Order all relevant investigations

FBC + CBS + Electrolytes

The full blood count is within normal parameters. The capillary blood sugar is 120 mg/dL. Serum Na+, K+ and Cl- are within normal parameters.

EEG

The EEG shows multiple waves of 2 to 3 Hz in the right temporal region, as well as high voltage spikes in the right frontotemporal area.

MRI brain

The MRI of the brain appears normal, with no evidence of hemorrhages, space occupying lesions, structural abnormalities or cerebral edema.

Lumbar Puncture

The CSF analysis is completely normal.


Step 3: Select appropriate management

Counselling
Surgery
Radiotherapy
Antipsychotics


Score: ★★☆