Epilepsy is one of the most common neurological disorders, and original observations in the field are often the key to diagnosis and successful treatment. Physicians new to the field as well as seasoned practitioners will benefit from more than one hundred case vignettes that explore the universe of epilepsy as it presents in daily practice. Some of these cases challenge long-held views about epilepsy and others bring the reader to the limits of our understanding of epilepsy, both in clinical and basic science. To improve the interface of clinical and basic science in epilepsy, basic scientists comment on the potential mechanisms underlying clinical observations, and clinicians assess the potential impact of recent results of experiments in the laboratory. Puzzling Cases of Epilepsy highlights the importance that original observations have in inspiring both new treatments and continued research.

Table of Contents:
Preface to the second edition List of Contributors Part I Diagnostic Puzzles and Uncertainties 1. A Young Woman with Mouth Jerking Provoked by Reading 2. Two Adult Patients with Infantile Spasms 3. An Infant with Partial Seizures and Infantile Spasms 4. Epilepsia Partialis Continua versus Non-Epileptic Seizures 5. Panic Attacks in a Woman with Frontal Lobe Epilepsy 6. Frequent Night Terrors 7. Genetic (Generalized) Epilepsy with Febrile Seizures Plus 8. A Visit to the Borderland of Neurology and Psychiatry 9. A Case of Complex Partial Status Epilepticus 10. Late-Onset Myoclonic Seizures in Down’s Syndrome 11. Fainting, Fear, and Pallor in a 22-Month-Old Girl Part II Intriguing Causes and Circumstances 12. Hyperactive Behavior and Attentional Deficit in a 7-Year-Old Boy with Myoclonic Jerks 13. Temporal Lobe Epilepsy, Loss of Episodic Memory, and Depression in a 32-Year-Old Woman 14. Epileptic “ Dreamy States ” in a Young Man 15. Nocturnal Seizures in a Man with Coronary Disease 16. Non-convulsive Status Epilepticus and Frontal Lobe Seizures in a Patient with a Chromosome Abnormality 17. An Unusual Cause of Nocturnal Attacks 18. Myoclonic Jerks in a Computer Specialist 19. Their Previous Physicians had Told Them that They Should not Become Pregnant Because They have Epilepsy 20. Status Epilepticus after a Long Day of White-Water Rafting in the Grand Canyon 21. A Farmer Who Watched His Own Seizures 22. The Borderland of Neurology and Cardiology 23. A Man with Shoulder Twitching 24. The Girl with Visual Seizures Who wasn’t Seeing Things – Transient Blindness in a Young Girl 25. A Young Man with Noise-Induced Partial Seizures 26. Non-convulsive Status Epilepticus in a Patient with Idiopathic Generalized Epilepsy 27. Pseudohypoglycemia Manifesting as Complex Partial Seizures in a Patient with Type III Glycogen Storage Disease Part III Surprising Turns and Twists 28. Recurrent Amnestic Episodes in a 62-Year-Old Diabetic Patient 29. Attacks of Nausea and Palpitations in a Woman with Epilepsy 30. Absence Status Epilepticus in a 60-Year-Old Woman 31. Hemiplegia in a 76-Year-Old Woman with Status Epilepticus 32. Persistence Pays Off 33. Drugs Did Not Work in a Little Girl with Absence Seizures 34. “ Alternative ” Therapy for Partial Epilepsy – with a Twist 35. A 19-Year-Old Man with Epilepsy, Aphasia, and Hemangioma of the Cranial Vault 36. Severe Psychiatric Disorder in an 8-Year-Old Boy with Myoclonic–Astatic Seizures 37. A Girl with Two Epilepsy Syndromes 38. The Obvious Cause of Seizures May Not Be the Underlying Cause 39. Absence Seizures in an Adult 40. A Case Solved by Seizures During Sleep 41. Alternative Psychosis in an Adolescent Girl? 42. Exacerbation of Seizures in a Young Woman 43. Genetic Counseling in a Woman with a Family History of Refractory Myoclonic Epilepsy 44. “ Funny Jerks ” Run in the Family 45. Side Effects That Imitate Seizures 46. Epilepsy, Migraine, and Cerebral Calcifi cations 47. An Unusual Application of Epilepsy Surgery 48. All is Not What it Seems 49. A Patient Whose Epilepsy Diagnosis Changed Three Times Over 20 Years 50. If You Don’t Succeed, Investigate 51. Should He or Shouldn’t He? Is It Reasonable to Prescribe Carbamazepine after Lamotrigineinduced Stevens–Johnson Syndrome? 52. The Value of Repeating Video–EEG Monitoring and the Importance of Concomitant ECG Tracings in the Evaluation of Changes in Seizure Semiology PART IV Unforeseen Complications and Problems 53. A 35-Year-Old Man with Poor Surgical Outcome after Temporal Lobe Surgery 54. When More is Less 55. Change of Antiepileptic Drug Treatment for Fear of Side Effects in a 45-Year-Old Seizure-Free Patient 56. Personality and Mood Changes in a Teenager 57. Monitoring Patients May Be More Important Than Their Laboratory Tests 58 Depression in a Student with Juvenile Myoclonic Epilepsy 59. Osteomalacia in a Patient Treated with Multiple Anticonvulsants 60. Parkinsonism and Cognitive Decline in a 64-Year-Old Woman with Epilepsy 61. Problems in Managing Epilepsy during and after Pregnancy 62. Status Epilepticus in a Heavy Snorer 63. A Boy with Epilepsy and Allergic Rhinitis 64. Seizures and Behavior Disturbance in a Boy 65. Abulia in a Seizure-Free Patient with Frontal Lobe Epilepsy 66. The Continuing Place of Phenobarbital 67. A Patient with Epilepsy Slips Down Some Attic Stairs 68. Bilateral Hip Fractures in a 43-Year-Old Woman with Epilepsy 69. Picking a Wrong Antiepileptic Drug for a 9-Year-Old Girl 70. With Epilepsy You Never Know Part V Unexpected Solutions 71. When Antiepileptic Drugs Fail in an Infant with Seizures, Consider Vitamin B6 72. A 12-Year-Old Boy with Daily Clonic Seizures 73. A Child with Attention-Defi cit Disorder, Autistic Features and Frequent Epileptiform EEG Discharges 74. Complete Seizure Control in a 14-Year-Old Boy after Temporal Lobectomy Failed 75. Ictal Crying in a 32-Year-Old Woman 76. Healing Begins with Communicating the Diagnosis 77. An Unusual Case of Seizures and Violence 78. Attacks of Generalized Shaking without Postictal Confusion 79. Lennox–Gastaut Syndrome with Good Outcome Associated with Perisylvian Polymicrogyria 80. Temporal Lobe Resection in a Patient with Severe Psychiatric Problems 81. An Open Mind Can Benefi t the Patient 82. An Unexpected Lesson 83. When Surgery Is Not Possible, All Hope Is Not Lost 84. Sometimes Less Is More 85. Unexpected Benefit from an Old Antiepileptic Drug 86. Status Epilepticus Responsive to Intravenous Immunoglobulin 87. Surgical Success in a Patient with Diffuse Brain Trauma 88. Dietary Treatment of Seizures from a Hypothalamic Hamartoma 89. Can the Behavioral and Cognitive Effects of AEDs Be Predicted? 90. A Child with So-Called Nocturnal Paroxysmal Dystonia Whose Epilepsy Arose from Orbital Cortex 91. The Night Mom Didn’t Come Back 92. The EEG – Not the EEG Report – Makes the Difference Part VI Where Clinical Knowledge and Preclinical Science Meet 93. The Double-Hit Hypothesis: Is It Clinically Relevant? Comment: The Double-Hit Hypothesis: Is It Clinically Relevant? 94. Atypical Evolution in a Case of Benign Childhood Epilepsy with Centrotemporal Spikes Comment 1: Does Kindling in Humans Occur? Comments Based on the Previous Case Study Comment 2: Does Kindling in Humans Occur? Comments Based on the Previous Case from a Preclinical Perspective 95. Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Patient with Recurrent Status Epilepticus as the Single Manifestation of Her Epilepsy Comment 1: Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Preclinical Perspective Comment 2: Does Status Epilepticus Represent a Different Pathophysiology than Epilepsy? A Clinical Perspective 96. Why Do Some Patients Seem to Develop Tolerance to AEDs? Development of Antiepileptic Drug Tolerance in a Patient with Temporal Lobe Epilepsy Comment 1: Why Do Some Patients Seem to Develop Tolerance to AEDs? A Preclinical Discussion Comment 2: How Can We Detect the Development of Tolerance (Loss of Effect) to AEDs in Patients with Epilepsy? A Clinical Discussion 97. Why Is There a Similar Ceiling Effect for the Efficacy of Most If Not All Antiepileptic Drugs in Adult Epilepsy? Reaching the Ceiling or Hitting the Wall? Comment 1: Why Is There a Similar Ceiling Effect for the Effi cacy of Most If Not All Antiepileptic Drugs in Adult Epilepsy? A Clinical Perspective Comment 2: What Clinical Observations on the Epidemiology of Antiepileptic Drug Intractability Tell Us About the Mechanisms of Pharmacoresistance 98. Difficult-to-Treat Idiopathic Generalized Epilepsy in a Young Woman Comment 1: Can We Predict a Drug’s Efficacy in a Specifi c Epilepsy Syndrome? A Preclinical Discussion Comment 2: Bridging the Gap between Evidence-Based Medicine and Clinical Practice 99. Psychogenic Non-Epileptic Seizures “ Redux ” Comment 1: Is There a Neurobiological Basis to Stress-induced, Non-epileptic Behaviors that Mimic Seizures? Comment 2: Evidence for a Neurobiological Basis for Non-epileptic Seizures 100. Why Does VNS Take So Long to Work? Comment 1: Commentary: Why Does VNS Take So Long to Work? 101. If at First You Don’t Succeed Comment 1: Why Antiepileptic Drugs Fail in Some Patients: A Preclinical Perspective Comment 2: The Continuing Conundrum of Reversible Drug-resistant Epilepsy: A Clinical Perspective 102. Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not? Comment 1: Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not? A Comment on the Evidence Comment 2: Why Do Some Patients Have Seizures After Brain Surgery While Others Do Not? A Clinical Perspective Index