When in doubt, return to fundamentals (seizure semiology)

• Published in: Epileptic disorders Vol. 25; no. 5; pp. 769 - 778
• Main Authors: Nordli, 3rd, Douglas R, Beier, Alexandra D, Galan, Fernando N
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-10-2023
• Subjects: Drug resistance; Epilepsy; Quality of life; Seizures; epilepsy; epilepsy surgery; seizure semiology; functional magnetic resonance imaging
• ISSN: 1294-9361; 1950-6945
• DOI: 10.1002/epd2.20140

This case of drug resistant focal epilepsy highlights several invaluable teaching points. Hypotheses grounded in seizure semiology provide the best framework to ensure accurate interpretation of diagnostic testing. Without a hypothesis, information gathered from tests can be difficult to linearly piece together and can lead to poor patient outcomes. The case also provides a real-world conundrum of discordant test results that were ultimately rectified by re-visiting the initial hypothesis and cross-testing. Perinatal stroke continues to be a common etiology of drug resistant epilepsy. Patients can achieve seizure freedom and good quality of life with appropriate workup and in appropriate cases, surgery.