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Clinical Crossroads Update
September 14, 2011

Update: A 24-Year-Old Woman With Intractable Seizures: Review of Surgery for Epilepsy

JAMA. 2011;306(10):1130. doi:10.1001/jama.2011.1328

In a Clinical Crossroads article published in December 2008,1 Donald L. Schomer, MD, and Peter M. Black, MD, PhD, discussed the epidemiology and pathophysiology of medically refractory seizures, as well as the long-term effects and potential treatments of poorly controlled seizures. The patient, Ms H, was a 24-year-old woman who had been experiencing seizures for 10 years. Ms H's seizures were determined to be simple partial and secondarily generalized, likely of left mesial frontal origin, nonlesional, and medically refractory. The seizures had a significant negative impact on Ms H's quality of life. At the time of publication, Ms H experienced 1 to 10 seizures nightly, involving primarily the right arm. Over 10 years, Ms H had been prescribed and taken a variety of medications to treat the seizures, including phenobarbital, lamotrigine, carbamazepine, topiramate, tiagabine, clonazepam, and ethosuximide, without reprieve. Ms H was considering surgical treatment for her condition, and Drs Schomer and Black debated the medical vs surgical treatments.