Epilepsy CCCCCCCCCaaaaaaaaassssssssseeeeeeeee SSSSSSSSStttttttttuuuuuuuuudddddddddiiiiiiiiieeeeeeeeesssssssss Pearls for Patient Care William O. Tatum Joseph I. Sirven Gregory D. Cascino Editors Epilepsy Case Studies Dkwily William O. Tatum (cid:129) Joseph I. Sirven Gregory D. Cascino Editors Epilepsy Case Studies Pearls for Patient Care Editors William O. Tatum IV, D.O. Joseph I. Sirven, M.D. Mayo Clinic in Florida Mayo Clinic in Arizona Neurology/Epilepsy Neurology Jacksonville , FL , USA Scottsdale , AZ , USA Gregory D. Cascino, M.D. Mayo Clinic in Minnesota Neurology Rochester , MN , USA ISBN 978-3-319-01365-7 ISBN 978-3-319-01366-4 (eBook) DOI 10.1007/978-3-319-01366-4 Springer Cham Heidelberg New York Dordrecht London Library of Congress Control Number: 2013951512 © Springer Science+Business Media New York 2014 This work is subject to copyright. 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Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) This book is dedicated to patients with epilepsy and their families—thank you for your education about seizures and about life. William O. Tatum IV Pref ace Sir William Osler said, “To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is to not go to sea at all.”* This book is about 40 people whose lives took a different course after they were affected by seizures and epilepsy. The chapters in this book represent case histories drawn from “real-life” experiences in people with seizures. The intent of presenting these patient histories in a case-based format is designed to stimulate the same deductive reasoning that is commonly used when seeing epilepsy patients in the clinic. The use of neuroimaging and neurophysiology in the study of patients with epilepsy has become a staple with which the diagnosis and treatment of epi- lepsy has become inextricably intertwined. Therefore, the correct interpretation of these studies is essential to reach the correct diagnosis and treatment. Following the clinical scenario composed of a wide variety of epilepsy cases, questions are posed to organize the reader’s thoughts in addressing each case. Questions that revolve around each patient include commonly asked questions such as, “How does this test help us with the diagnosis?” and “What is the precise relationship of the patient’s seizures to their overall neurological condition?” The most poignant questions include, “How does this information help us to devise a treatment plan?” and “What do we know about the anticipated course and prognosis?” The questions raised in each section incorporate answers to these questions about diagnosis, treatment, and prognosis where the a knowledge base exists. They are addressed in a segment of the book that focuses on a discussion of the facts of the case. Where it is possible, these discussions rely upon the latest medical evidence to support the responses. At the end of each case a few salient citations are included. Our hope to provide an overview of the topic and search for an expanded bibliography, if they so desire. We learn from every patient. Our “take-home” messages are encapsulated in the form of clinical pearls that shape the basis of our understanding. Furthermore, these pearls of wisdom guide our decision-making in the approach to treatment of future patients with similar case scenarios. There is simply no written text that can replace the knowledge that is derived from hearing and seeing our patient and what they tell us. Our overreliance and overuse of “tests” will never replace the clues that our patients give us when we perform the neurological history and examination. vii viii Preface The fi eld of epileptology encompasses some of the most dynamic and dramatic conditions that a Neurologist will face. Little is more surprising in the fi eld of Medicine than the spontaneity and unpredictability of seizures. Case Studies in Epilepsy will aid in selecting the approach to a clinically based problem list in a style that we hope stimulates reasoning in a style that is fun. From cases that include fi rst onset seizure to drug-resistant epilepsy, from seizures stemming from unknown causes to those produced by a brain tumor, from infancy to the elderly, diagnostic dilemmas and treatment challenges exist and require an individualized approach. Standard and novel diagnostic associations with seizures including genetics and autoimmunity are addressed in addition to nonmedical treatment options including epilepsy surgery, neurostimulation, dietary control, and alternative medicine. These topics are well represented by 40 illustrative case studies contained in this book. An introduction to some of the emerbing treatments such as newer anti-seizure drugs, neurostimulators, and minimally-invasive brain surgeries for epilepsy are included. The cases themselves, serve as the platform to highlight and encompass the broad group of the epilepsies including those with genetic, structural-metabolic, and unknown causes. These cases were obtained from expert epilepsy clinicians at the Mayo Clinic. It is widely known that even in the most productive academic circles, even the most educated in epilepsy centers may be heard to say, “I remember that I once had a case of …”. *Osler W. Books and men. Boston Med Surg J. 1901;144:61. Jacksonville , FL , USA William O. Tatum IV, D.O. Acknowledgment I am grateful to my colleagues at the Mayo Clinics for both the opportunity to work with them and to learn from them. This multiauthored enterprise-wide work has been compiled by many outstanding epileptologists that have contributed freely and generously of their time. It serves as a testimony to their dedication to the fi eld of epilepsy. Each author has presented a specifi c vignette that represents a patient who suffered from an individual affl iction of epilepsy. It is not the symptom that is remembered, but rather it is the person who imprints the case on our minds. To a large degree, our collective experience in patient care has been shaped by the unique qualities of a single patient whose story has impacted our own lives. These individu- als quickly come to mind when we need an example to serve as a prototype for a certain syndrome or situation. One of my favorite mentors fi rst taught me that it is the needs of the patients that come fi rst in delivering the best neurological care possible. That people are behind the symptoms of their illness and that treatment begins with compassion and advo- cacy by a human touch. The stigma and painful lack of predictability with seizures that patients and their families endure is something that most of us will hopefully never know. The cases described in this book while presented in a didactic fashion lack the emotional coloring behind each case too shallow to be appreciated. I hope that the readers of this book will never experience a seizure. Instead, I hope that these 40 stories, which are drawn from real-life experiences, can portray the breadth and individuality of epilepsy and therein provide education and compassion that in some way is able to help at least 1 person with seizures. Jacksonville, FL, USA William O. Tatum IV, D.O. ix