CASE PRESENTATION
A 36-year-old, right-handed male, as confirmed by the Edinburgh
Handedness Inventory,[4] presented with
non-lesional refractory frontal-lobe epilepsy, diagnosed at 16 years of
age, and with a history of four hospitalizations for refractory status
epilepticus (SE); medically induced coma was required. The patient was
admitted to the intensive care unit with focal seizures in the right
upper limb, impaired consciousness, and recurrent progression to
bilateral tonic-clonic seizures, with mirror-writing episodes at a
frequency of one every 1–6 months; the electroencephalogram (EEG)
showed no signs of ongoing SE (Figure 1). After infectious and metabolic
etiologies were excluded and convulsive SE was diagnosed, the patient
was treated with intravenous lacosamide (200 mg), levetiracetam (1.5 g),
diazepam (40 mg), and phenytoin (1 g). However, the episodic seizures
continued. After regaining consciousness following a seizure, the
patient had a spontaneous 4-min-long episode of mirror writing with his
left hand (Figure 2), lasting until the onset of another seizure (Figure
3). The patient did not speak or respond to verbal commands during the
episode. As the patient was unresponsive to treatment, anesthetic
induction and deep sedation were required to manage the SE; bispectral
index monitoring was used. Under deep sedation with propofol infusion,
the EEG did not reveal any paroxysmal activity, and the patient
recovered with a good neurological outcome and no sequelae. The
patient’s family members reported eight mirror-writing episodes
following seizures in the previous 4 years; the patient did not remember
these events.