Refractory focal epilepsy as a rare clinical presentation of systemic lupus erythematosus

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune multisystem disease with prominent neuropsychiatric manifestations. Neuropsychiatric features are seen early in the course of disease with seizures forming one of the most frequent manifestations of Neuro Psychiatric Systemic Lupus Erythematosus (NPSLE). The mechanism of seizure is contemplated to be immune mediated. Both generalised and focal seizures are seen in SLE. They can sometimes be the only symptom marking the onset of disease in the absence of other commonly encountered clinical features of the disease. We report cases of two young females who were diagnosed and treated as drug resistant focal onset seizures with impaired awareness which later turned out to be NPSLE. Both patients showed dramatic response when initiated on immunotherapy. These cases highlight the importance of considering an immune mediated process when a young female presents with pharmacoresistant localisation related epilepsy.