A 35-year-old woman develops focal onset impaired awareness seizures that are refractory to two adequate antiseizure medications (ASMs) at therapeutic doses. She is referred for pre-surgical evaluation. MRI shows left hippocampal sclerosis. EEG confirms left temporal lobe ictal onset. This patient has:

• A Lennox-Gastaut syndrome
• B Drug-resistant (refractory) mesial temporal lobe epilepsy (MTLE) ✓
• C Juvenile myoclonic epilepsy (JME)
• D Autoimmune limbic encephalitis

Explanation

Drug-resistant epilepsy is defined by the ILAE as failure of adequate trials of two tolerated, appropriately chosen ASMs (as monotherapy or combination) to achieve sustained seizure freedom. Mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis is the most common surgically remediable epilepsy syndrome in adults. MTLE often presents with deja vu, autonomic symptoms, and complex partial seizures with post-ictal confusion. Temporal lobectomy or laser ablation (LITT) achieves seizure freedom in 60–80% of carefully selected patients.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.