Picture 4. Post-hyperventilation EEG showing occasional multifocal mainly bitemporal bursts of spike-and-waves.
A period of seizure freedom occurred from age 9 to 11 occurred after commencing acetazolamide. There was no history of absence seizures or myoclonic seizures, meanwhile, episodes of staring spells with no EEG changes were noted. The follow-up wakefulness EEG findings showed stabilization, meaning a regular brain activity of alpha rhythm with isolated right-sided spike-and-wave bursts.
Thereafter, followed a period of frequent twice-a-week generalized tonic-clonic seizures and one focal epileptic seizure. Levetiracetam was included in the antiepileptic treatment. Repeat wakefulness EEG findings showed focal bursts of left-sided parieto-occipital and temporal spike-wave discharges. (see picture 5). Epilepsy protocol magnetic resonance imaging of the brain was normal.