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Epilepsy is a complex neurological disorder that remains misunderstood in many aspects, particularly when the condition emerges without a clear structural or genetic basis. Among the most challenging presentations is treatment & drug-resistant focal epilepsy that evolves over time and fails to correlate with standard diagnostic tools. This article narrates a real-world, long-term case study of such a condition, not as a personal story, but as a research-oriented case profile, offering insights into diagnosis delays, medication resistance, psychiatric interplay, and long-term neurological adaptation.
During adolescence—a critical stage of neurological maturation—this case involved an early psychiatric intervention using two potent medications:
Risperidone, an antipsychotic, prescribed to suppress perceived “mind flow” or thought hyperactivity.
Escitalopram, a selective serotonin reuptake inhibitor (SSRI), introduced later to compensate for the suppressive effect caused by Risperidone and re-stimulate normal cognitive-emotional flow.
Both medications were administered in the absence of a clear psychiatric diagnosis—a situation not uncommon in early behavioral intervention attempts, where neurodivergent traits or behavioral irregularities are misinterpreted. (Read how behaviour irregularities are misinterpreted) The brain, during adolescence, is still undergoing major structural and chemical development. Administering dopaminergic and serotonergic modulators during this phase can lead to unpredictable long-term neuroplastic outcomes.
In this case, these medications may have altered neurochemical balance in a way that could have contributed to future seizure activity, potentially creating vulnerability to the abnormal electrical activity patterns that later manifested as focal seizures.
Phase 1 (2017–2023): Clustered Seizure Episodes
Pattern: Tonic-clonic seizures occurring once every 15–20 days.
Unique Feature: Seizures typically occurred in clusters—5 to 6 episodes in a single day.
Clinical Challenge: No structural lesion identified on MRI; EEG results were normal, complicating diagnosis and treatment selection.
Phase 2 (Post-2023 IV Intervention): Transition to Focal Epilepsy
A major shift occurred after IV administration of Levetiracetam (1g) during a crisis episode. This single event appeared to not only halt secondary generalization but also convert the seizure type from tonic-clonic to focal. The focal seizures then began to manifest as follows:
Loss of awareness for 1–2 minutes.
Followed by 20–30 minutes of altered consciousness: the patient remained physically responsive (talking, walking, eating) but transient dissociative unawareness with no post-event recall
Phase 3 (Since September 2024): Increased Frequency and Trigger Sensitivity
Frequency worsened to twice a week.
Trigger Patterns: Seizures consistently began during eating or active body movement, indicating possible reflex or activity-sensitive epilepsy patterns.
Quality of Life Impact: More intrusive episodes, increasing anxiety around daily tasks.
Over the span of years, several medication combinations were trialed. Despite limited long-term success, there were three distinct treatment windows where partial or full seizure control was achieved:
Topiramate + Phenytoin + Clobazam + Clonazepam – Controlled seizures for 8 months.
Brivaracetam Monotherapy – Controlled seizures for 3 months.
IV Levetiracetam – Brought about a notable shift in seizure type and reduced cluster episodes.
Most anti-seizure medications tried over the years had temporary efficacy. Several combinations worked briefly but could not maintain long-term seizure freedom.
Despite multiple rounds of diagnostic testing, including:
… no abnormality or epileptogenic focus was found. This lack of evidence strongly points to non-lesional epilepsy, a form that eludes conventional diagnostics and is increasingly recognized in idiopathic focal seizure cases.
What distinguishes this case is the timing and type of psychiatric drug exposure during brain development. The adolescent use of Risperidone (a dopamine D2 antagonist) followed by Escitalopram (a serotonin reuptake enhancer) suggests a possible neurochemical destabilization, even in the absence of any core psychiatric illness.
Modern neuropsychiatry says that dopamine and serotonin—two important brain chemicals—are closely linked to how active or calm the brain is. These chemicals help control brain signals and keep them balanced, which is important in preventing seizures. If these brain systems are disturbed for a long time during teenage years, it might change the brain’s normal balance and slowly increase the chances of seizures in the future.
While this remains hypothetical, this case encourages further exploration into the link between early psychiatric interventions and future neurological conditions to revisit the impact of unnecessary early psychiatric interventions—particularly when not clinically confirmed—may warrant closer evaluation especially in individuals who later develop idiopathic epilepsy. A few epileptologists have came across patients who have a history of the same case.
As seizures became more frequent and harder to anticipate, questions arose around on-the-spot control strategies. Although Clobazam is taken daily, the idea of using it sublingually during pre-ictal phases is being considered. According to many sources, Clobazam is not a part of standard emergency protocols.
However:
Clobazam is not classified as a rapid-onset rescue medication.
Benzodiazepines like Midazolam or Lorazepam are typically more effective for real-time intervention.
There’s a need to customize emergency protocols for mild pre-ictal awareness or reflex triggers, which aren’t widely addressed in standard epilepsy care.
This case illustrates how epilepsy can evolve unpredictably over time, and how early psychiatric interventions—especially without conclusive diagnoses—might unknowingly shape the trajectory of neurological disorders later in life.
From tonic-clonic clusters to non-lesional focal seizures, from therapy-resistant periods to brief phases of remission, the complexity of this journey underscores the urgent need for a more integrative approach in epilepsy diagnosis and management.
Neurologists, psychiatrists, and clinical researchers must work together to identify such patterns, especially in youth populations exposed to mood-altering drugs during neurodevelopment. This case, though individual, offers broader clinical and research implications that demand closer examination in the growing domain of idiopathic focal epilepsy.
Note : This research is completely based on a single patient’s history. A few information were gathered from experienced doctors out of curiosity. Can’t come to a common conclusion for all epileptic patients.
“All content shared on this website represents my personal views and perspectives. It is not meant to impose beliefs, and readers may have different interpretations or opinions.
It is always good to explore sensitive topics through multiple sources for a well-rounded understanding.”
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