2021 Epilepsy Quiz-A-Day #7

Epilepsy Quiz-A-Day #7

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A 2 year old boy has frontal lobe seizures and a lesion shown in the T1 axial MRI image below. An initial trial of levetiracetam resulted in reduction but not cessation of seizures. He continues to have focal impaired awareness seizures once weekly on optimized doses of lamotrigine monotherapy. What course of action is most likely to result in long term seizure freedom?

Combination therapy with valproate and lamotrigine

Ketogenic diet initiation using a 4:1 ratio until he is old enough for surgery

Surgical evaluation and resection now

Surgical evaluation and resection if seizures are not resolved by 8 years of age

Vagus nerve stimulator implantation