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.