Landau-Kleffner Syndrome: the challenges of its treatment

Case presentation: A previously healthy 3-year-old boy presented with difficulty understanding commands and developed impairment of spoken language that lasted four months remitted spontaneously. After 10 months, he suffered again regression. Electroencephalogram (EEG) revealed electrical status epilepticus during sleep (ESES). He was treated sulthiame, sodium valproate clobazam partial improvement. One year later, after an episode COVID-19 infection, symptoms worsened prescribed lamotrigine, levetiracetam low dose prednisolone response. a few following otitis, became severely ataxic completely aphasic searched our hospital. unable to sit stand without support also episodes absences. EEG persisted ESES. Brain MRI normal. started on 5 days methylprednisolone immunoglobulin. By the time discharged, already able speak words walk independently. We decided perform monthly steroid pulse therapy associated ketogenic diet. third month treatment, showed significant improvement ESES not observed. fifth course methylprednisolone, surf skateboard evolved marked speech is currently tapering his last shows rare centrotemporal paroxysms.