False Drug Resistance in Suspected Epilepsy: A Case Report
Garik G. Yeganyan1*, Hasmik D. Hambardzumyan2, Elza A. Balian3,4, Lilit G. Atabekyan3,
Nune S. Yeghiazaryan2,4, Samson G. Khachatryan3,4
1 Department of Neurology and Stroke, Gyumri Medical Center, Gyumri, Armenia
2 Department of Neurology, Erebouni Medical Center, Yerevan, Armenia
3 Sleep, epilepsy and movement disorders center, Somnus Neurology Clinic, Yerevan, Armenia
4 Department of Neurology and Neurosurgery, Avdalbekyan National Institution of Health, Yerevan, Armenia
ABSTRACT
About one-third of patients with epilepsy develop drug resistance despite appropriate therapy. However, in some cases, resistance reflects misdiagnosis rather than true pharmacoresistance. Other conditions such as psychogenic nonepileptic seizures, movement disorders, and metabolic abnormalities, may mimic epilepsy. We report a case of a 69-year-old woman with a 17-year history of presumed drug-resistant epilepsy who was eventually diagnosed with insulinoma with prolonged paroxysms of transient loss of consciousness. This case illustrates the importance of reconsidering the diagnosis in refractory epilepsy, especially with atypical features or late onset.
Keywords: Drug-resistant epilepsy; Pseudoresistance; Seizure semiology; Hypoglycemia; Insulinoma, Epilepsy mimics