Case report Curable focal epilepsy

This gentleman presented, aged 36, with numbness on the left side of his face, which subsided over 10 days. Four months later, he developed numbness with pins and needles affecting his left arm followed shortly affecting his right arm and then both legs within a month. Magnetic resonance imaging (MRI) brain showed two white matter lesions involving the corpus callosum with no other abnormalities. MRI whole spine revealed high signal abnormalities at C2, C3, T7 and T8. He was subsequently diagnosed with multiple sclerosis (MS). He responded well to steroids and was commenced on interferon beta-1A. He remained well for the next 2 years with no further relapses with an expanded disability status scale (EDSS) score of 0. He then complained of a sensory disturbance in both thighs and knees with some urgency with a documented EDSS of 1.5. A few months later he stated to complain of a metallic taste in the mouth followed by loss of awareness but without losing consciousness. He had two to three of these stereotypical attacks per day over the course of 2 months. Imaging revealed an enhancing lesion in the right insular cortex (Figure 1), which was considered a relapse and the anatomical substrate of his ‘seizures’. After 3 days of iv methylprednisolone he made a good recovery.