A case of late onset drug-resistant epilepsy associated with chronic Epstein-Barr virus encephalitis

Drug resistant epilepsies represent 25% of epilepsies and lead to a debilitating prognosis with low quality of life. This requires a correct diagnosis in each patients to verify the real drug-resistance. We describe a case of a old woman that began presenting seizure at age of 70. For several years the patient was treated for a cryptogenic drug resistant epilepsy. She presented also a cognitive decline and loss of autonomy. After a prolonged post-ictal state the patient was admitted to our department and we investigated the possible causes with several tests. The EEG was characterized by spread slow waves. MRI excluded acute events. We found a CSF positivity for EBV PCR. We started Acyclovir and steroids with a rapid clinical and EEG improvement. After a follow up of 6 month the patient is seizure free.