Clinical Reasoning: Seizures from the neglected lobe.

SECTION 1 An 11-year-old, right-handed girl with normal development, no significant medical history, and no known epilepsy risk factors presented to the clinic for evaluation of new-onset epilepsy. Her first unprovoked seizure began with the symptom of “blurry vision” and an “inability to see right.” Minutes later, she started to turn clockwise, her right arm pointing in the air, in a nonpurposeful manner, before her body “became very limp” and she collapsed. Subsequently, she had several convulsive seizures requiring IV benzodiazepines and temporary intubation. Over the next 2 months, the patient continued to have stereotyped seizures. All seizures were preceded by sensory auras of the right arm and occasional foot numbness and tingling paresthesias, as well as by frequently simultaneous complaints of “blurry vision” or complete “loss” of vision. Then there would be a forced head version with tonic gaze deviation to the right, and finally a hemi-tonic-clonic activity of the right arm . leg, with full-body version to the right.