Seizure Type Change in Temporal-Lobe Epilepsy: A Case Report

Seizure type changes or evolution can sometimes occur. The most known seizure type evolution is focal onset to bilateral tonic-clonic seizure while other forms of seizure type changes are rarely reported. A 46-year-old man with generalized tonic-clonic seizure pattern undergo changes in seizure type into motoric patterns (automatism) followed by confused period similar to temporal-lobe epilepsy symptoms. Patient was initially given phenytoin and clobazam for generalized tonic-clonic seizure. After he was diagnosed with temporal-lobe epilepsy, carbamazepine was added and seizure completely ceased afterwards. Patient was discharged after 3 seizure-free days. Epilepsy is defined as a disease which fulfils one of these criteria: two or more reflex or unprovoked seizure with 24-hour interval, one reflex or unprovoked seizure with the probability of another seizure repeating in the next 10 year ≥60%, or epilepsy syndrome. Temporal lobe is the most epileptogenic area in the brain, because seizure-causing injury often occurs in this area. This patient was initially given phenytoin and clobazam to treat his generalized tonic-clonic seizure. After the seizure type change, he was given carbamazepine which is one of the mainstay therapies for temporal-lobe epilepsy. Change of seizure type from generalized tonic-clonic to other types rarely occurs. In this case, we present a generalized tonic-clonic seizure patient which then evolves into temporal-lobe epilepsy. The diagnosis and classification of epilepsy is extremely important as they would ultimately determine patient’s treatment. Keywords: epilepsy, temporal lobe, seizure type change