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Antiepileptic-induced seizure exacerbation has been increasingly reported.1 Some paradoxical reactions are well known, whereas others are less established. We report a patient with benign focal epilepsy of childhood with centrotemporal spikes (BECTS) who had a paradoxical response to oxcarbazepine.
The patient had a history of mild language delay. She had her first seizure at age 7 and a second at 9. EEG demonstrated left centrotemporal (C3/T7) spikes with a horizontal dipole distribution and activation by drowsiness, a morphology consistent with benign focal epileptiform discharges of childhood (BFEDC) (figure, A). Over the next 6 months, she had three more nocturnal seizures followed by multiple nocturnal seizures over 3 days. All seizures were generalized tonic–clonic or hemiclonic seizures occasionally with a postictal Todd paralysis. She was briefly treated with valproate, which was discontinued owing to sedation. Carbamazepine was attempted but discontinued after the development of somnolence and episodes of eye fluttering. She continued to …
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