Role of levetiracetam in refractory seizures due to a rare progressive myoclonic epilepsy: Lafora body disease

Abstract

Lafora disease is one of the rare, most fatal progressive myoclonic epilepsies reported. We present a case of a teenager with intractable seizures and progressive mental decline, diagnosed as Lafora body disease on axillary skin biopsy. He was admitted with status epilepticus with refractory myoclonic and generalised tonic clonic seizures. Despite on maximum doses of multiple antiepileptic drugs and infusions of propofol and midazolam, his seizures were refractory to all forms of medical therapy tried. Levetiracetam (LEV), a pyrrolidine derivative, was introduced; he showed a prompt response and was weaned off successfully from infusions of anticonvulsants and mechanical ventilation within 48 h of introduction of LEV, followed by an almost seizure-free status.

Figure 1

EEG showing generalized polyspike and slow wave discharges.

Figure 2

(A,B) Axillary skin biopsy demonstrating Lafora bodies (arrows) positive for periodic acid-Schiff.