A 50-year-old man with a medical history of epilepsy so far treated with levetiracetam was admitted to our department of neurology with an unprovoked complex focal status epilepticus. He had turned his head first to the right side followed by an adversive movement of the head to the left side. During this period, he was unresponsive to verbal or mechanical stimuli. EEG showed continuous focal sharp wave complexes indicating epileptic activity of the right occipital lobe (Figure 1A). Consistently, MRI made the status epilepticus visible by a region of reduced diffusion at the right occipital lobe (Figure 1B). Only upon treatment escalation to four antiepileptic drugs, levetiracetam, clonazepam, phenytoin, and lacosamide, the status epilepticus could be terminated. EEG as well as MRI normalized subsequently (Figure 1C). No structural MRI abnormalities could be detected at the region of the focal status epilepticus. EEG is the gold standard in capturing epileptic activity in patients especially in nonconvulsive status epilepticus. MRI techniques including diffusion-weighted imaging provide additional information [1,2].
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