LS is a 31-year-old woman presenting with her first unprovoked seizure. The clinical features suggest a focal onset seizure with secondary generalization, pr

LS is a 31-year-old woman presenting with her first unprovoked seizure. The clinical features suggest a focal onset seizure with secondary generalization, preceded by an aura (rising abdominal sensation, metallic taste) consistent with temporal lobe epilepsy. Temporal lobe epilepsy is a type of epilepsy where seizures begin in the temporal lobe. Your temporal lobe helps you make sense of the world around you through memory, sound vision and speech (Cleveland Clinic , 2025).

An important risk factor in LS past medical history is her febrile convulsion at the age of 10. Although febrile seizures in children are common in her case since it occurred at the age of 10 and was prolonged with associated focal features are associated with a higher risk for temporal lobe epilepsy later on in life. This raises the possibility of mesial temporal sclerosis or another underlying temporal lobe pathology.

The initial work up would include for LS to obtain an EEG along with an MRI of the brain. The EEG was already preformed on this case given the findings of epileptiform discharge as seen in the right temporal lobe which increases the risk of reoccurrence therefore seizure medication would be necessary. In LS’s case an MRI may reveal mesial temporal sclerosis, tumors, cortical dysplasia or scarring. This helps with diagnosis confirmation and planning for long term management.

First line options for focal-onset seizure medications include: Levetiracetam. This medication is used to control certain types of seizures such as partial onset seizures myoclonic seizures, or tonic-clonic seizures (Mayo Clinic , 2025). LS is already on fluoxetine with is an SSRI, levetiracetam is a good initial choice due to the minimal interactions. LS next step in coping with her current situation is to start antiseizure therapy immediately, schedule a brain MRI (which was done), counsel of seizure safety, driving precautions and lifestyle modifications. It is imperative that LS is able to identify when a seizure is going to occur. She would also need a referral to a neurology and an epilepsy specialist.

References

Cleveland Clinic . (2025, january 5). Retrieved from Temporal Lobe Epilepsy : https://my.clevelandclinic.org/health/diseases/17778-temporal-lobe-seizures

Mayo Clinic . (2025, May 1). Retrieved from Levetiracetam : https://www.mayoclinic.org/drugs-supplements/levetiracetam-oral-route/descr

National Institute for Health and Care Excellence (NICE). (2022). Epilepsies: Diagnosis and

management. https://www.nice.org.uk/guidance/ng217