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This teenager is being worked up for medically intractable epilepsy at a comprehensive, surgical epilepsy center. Implantation of stereotactic depth electrodes (stereotactic EEG) are being placed into regions of presumed seizure onset— in this case, the right hemisphere with coverage of the right temporal and parietal regions, along with the right insular region. If able to identify a clear seizure focus, this patient may be a candidate for laser ablation of seizure onset or open surgical resection.

The images provided are of the post surgical CT scan showing the bolts which are placed into the skull and subsequently holding the depth electrodes in place. These trajectories are planned using computer software and then carried out using the ROSA® robot (Robotic operating surgical assistant) which guides electrode placement with anatomical accuracy of less than 1mm. Once leads are placed, patient is monitored in our Epilepsy Monitoring Unit (EMU) for several days until enough data is collected about their seizures by the epilepsy team.

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\ \ Background\ Epilepsy is a disorder where seizures are caused by abnormal electrical discharges from the brain. Absence epilepsy involves seizures that cause a sudden loss of awareness. It often starts in childhood or adolescence. Three antiepileptic drugs are often used for absence epilepsy: valproate, ethosuximide and lamotrigine.\ This review aims to determine which of these three antiepileptic drugs is the best choice for the treatment of absence seizures in children and adolescents.\ Results\ The review found some evidence (based on eight small trials) that individuals taking lamotrigine are more likely to be seizure free than those using placebos. The review found robust evidence that patients taking ethosuximide or valproate are more likely to be seizure free than those using lamotrigine. However, because of the lower risk of adverse effects, the use of ethosuximide is preferred over valproate in patients with absence childhood epilepsy.\ With regards to both efficacy and tolerability, ethosuximide represents the optimal initial empirical monotherapy for children and adolescents with absence seizures.\ The evidence is current to September 2020.](https://app.figure1.com/case-detail/7a014af7-f0af-4cb5-85ab-09435404667e)

\ \ This is an update of a review first published in 2010.\ Background\ Epilepsy is a common neurological (brain) condition that is characterised by repeated seizures. Most people can control their seizures with a single antiepileptic medicine, however, about 30% continue to have seizures. These people are said to have drug‐resistant epilepsy. Lamotrigine is an antiepileptic medicine, which can be used as add‐on treatment with other antiepileptic medication to try to manage drug‐resistant epilepsy.\ Aim of review\ This review studied whether lamotrigine was effective and tolerable when used as add‐on treatment, alongside other antiepileptic medicines, for people with drug‐resistant generalised epilepsy (affecting the entire brain from onset) with tonic clonic‐seizures (seizures where people lose consciousness and jerk quickly and rhythmically).\ Results\ We found three trials, involving 300 people, that investigated lamotrigine for people with drug‐resistant generalised tonic‐clonic seizures. People who received add‐on lamotrigine were almost twice as likely to have a 50% or greater reduction in the number of generalised tonic‐clonic seizures than people who received add‐on placebo (an inactive, dummy drug). Lamotrigine did not significantly affect: the number of people who were completely free of seizures, the number of people who withdrew from treatment, or the number of people who experienced common adverse effects.\ However, we are very uncertain whether these findings are accurate. This is because there were not many people involved in the studies, and we are unclear about the methods some of the studies used. For this reason, we cannot comment on the use of lamotrigine.\ More trials, which include more people, and are carried out over longer time periods are needed to properly guide the use of lamotrigine for people with drug‐resistant generalised tonic‐clonic seizures.\ The evidence is current to March 2019.](https://app.figure1.com/case-detail/aa90d973-21e1-4c05-ab8b-1a9b7ea8f7de)

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