Epilepsy, epileptoma, surgery (based on clinical case data)

Abstract

Tumor-associated epilepsy is a comorbid disease with focal symptoms or focal, bilateral tonic-clonic seizures. This paper presents the case of a 36-year-old woman hospitalized due to frequent generalized seizures with focal onset and marked pharmacoresistance. The first epileptic seizure occurred at the age of 23 at night during sleep, manifested by tonic seizures with turning of the head to the right, impaired consciousness. The patient took lamotrigine and lacosamide, which resulted in remissions, but freedom from seizures was not achieved. MRI revealed structural changes in the medio-basal regions of the right temporal lobe. PET-CT revealed signs of metabolically active tumor tissue in the right temporal region.Based on the findings, it was concluded that the patient had a ganglioglioma. The patient underwent selective resection of the area of structural changes in the basal parts of the right temporal lobe. By the time of her discharge from the hospital on the 10th day after the surgical intervention, her general condition had fully recovered, no generalised seizures were noted in the postoperative period. During the evaluation of the catamnesis, an isolated aura occurred once. The presence of the disease significantly impaired the patient’s work activity, quality of life and socialisation and led to a depressive episode. This surgical intervention significantly reduced the patient’s quality of life. Thus, tumor-associated epilepsies caused by epileptomas are characterized by pharmacoresistance. Drug treatment did not have a stable effect and the course of the disease was accompanied by a recurrence of seizures. Surgical treatment is the method of choice. With the development of modern neurosurgery, cognitive functions could be preserved despite the long history of the disease.