Dr Jayanti Mani: Pre surgical neuropsychological evaluation of a 23 year old man with h/o seizure disorder

    Nishit had his first seizure at 6 years of age, he had headache, retching, head turning to the  righ followed by whole body shaking and loss of consciousness.  He was taken to a GP and by that time he had a generalized convulsion. He was started on AED therapy but the drug compliance was poor. Mom chose to opt for homeopathy.  After 1 ½ year, he had an episode where he complained of inability to see followed by eyes and head version to right and unresponsiveness for few minutes. This time she consulted an allopath and anti epileptic medications were started. AED's were started regularly after this episode.

    Several medications were tried over the years.  Nishit continued to have brief spells of visual blurring and vomiting once or twice a month, rarely in clusters of 3-4 a day.  Over the years, his seizure intensity and frequency have decreased with medications but complete seizure control has not been achieved. Currently, he gets 1-3 events per month and at times they occur in clusters. His current seizures are described as beginning with an aura (he cannot describe the sensation) followed by coughing and feeling of nausea with hand automatisms; he is drowsy post ictally.
    He is presently on 3 different medicines for his seizures: T .Levipil 1500mg BID, T Valance 500-0-750,  Oxetal 600mg BID

    The mother had taken Nishit to several  senior medical professionals in Mumbai and Delhi.  He also underwent a video EEGin 2009  to evaluate the seizures. Surgery was suggested but not  strongly recommended and he was continued on medications. Nishit and his mother finally came to the Epilepsy centre at KDAH in early 2014.

    Educational and Occupational History
    Nishit was reported to be a low average student through his school years. He was given some concessions in school in view of his recurrent seizures. He dropped out of college in his second year of graduation as he was finding it effortful to cope with academics. He is currently doing accounts work in an office and reports of no significant difficulties at work.

    Psycho- Social History
    Nishit's mother reported that he a stubborn and short tempered individual. He is an introvert person and does not socialize much. He is mistrustful and insecure and takes long to get along with people.

    Medical Details Of  The Treatment
    Nishit underwent a comprehensive presurgical evaluation at KDAH.  Brain MRI showed a subtle lesion in the right temporal region of the brain.  While this lesion was not very clearly visualised on MRI. The Video EEG, ictal SPECT and PET brain scans  and the neuropsychological assessment for memory all pointed to the same area as the seizure focus.  The epilepsy team in KDAH reviewed all the tests and offered him a temporal lobectomy.

    Surgery was done in October 2014.  Nishit has been seizure free since surgery till date (June 2016).  He is now on tapering doses of the medication and is a seizure free life.