Brain tumor and epilepsy

A 30-year-old patient had a 3- to 4-year history of recurrent focal seizures. He was diagnosed with localization-related epilepsy manifested as recurrent focal seizures associated with a sudden behavioral arrest, vacant stare, and right upper extremity dystonic posturing. The duration was brief and was associated with postictal amnesia and word-finding difficulties. Rare nocturnal generalized tonic-clonic seizures also occurred. His neurological examination was unremarkable except for the mental status testing that demonstrated abnormal short-term memory. Routine EEG shows bitemporal epileptiform discharges which were most prevalent on the left during sleep. A CT of the brain was normal. The patient's seizures were refractory to phenytoin, carbamazepine, lamotrigine, and levetiracetam. MRI brain showed a focal lesion in the left medial temporal lobe (Fig. 12.1). The appearance suggested a primary brain tumor.