Picture 6. Wakefulness EEG findings showing multifocal bilateral paroxysmal discharges of spike-and-wave 2 c/s, lasting 3-4 seconds.
The patient was not seizure-free for a long period of time. He had tonic-clonic generalized epileptic seizures once a week in the following years. In the epileptic treatment another AED, oxcarbazepine, was added. The EEG findings during this period showed focal bursts of right-sided spike-and-wave. After a short period of time, exactly a two-week period, oxcarbazepine was excluded, due to allergic reaction regarding the drug, and topiramate was added. Valproate was excluded from the treatment.
The period that followed was characterized by 2-3 tonic-clonic generalized epileptic seizures per month. Topiramate was excluded and lamotrigine was added. No allergic reaction was noted. For a short period of a few months, he was seizure-free. Now the patient is on treatment with lamotrigine, he is not seizure-free completely, but stabilized and has only a few seizures per year. The follow-up wakefulness EEG findings showed regular beta rhythm with right-sided multifocal bursts of spike-and-slow waves.
His seizures proved difficult to control from age 12 when generalized tonic-clonic seizures recurred reaching a frequency of up to 2-3 seizures per month, despite trials of lamotrigine, levetiracetam, and topiramate. A trial of topiramate in combination with lamotrigine led to a marked reduction in seizure frequency, reducing to three generalized tonic-clonic seizures in the year following treatment initiation.