Case Presentation:
A 55-year-old man was diagnosed with a left temporo-insulo-parietal left tumor after developing focal cognitive seizures with aphasia and complex visual hallucinations (fig. 1). He underwent partial tumor resection resulting in persistent dysphasia. The histopathology diagnosis was compatible with a glioblastoma. He was medicated with levetiracetam and sodium valproate due to increasing of seizure frequency, characterized by transitory worsening of previous dysphasia. He started treatment with chemotherapy and radiotherapy (according to STUPP protocol), with an initial good radiological response. While undergoing oral chemotherapy cycles, he was admitted in the Emergency Room, desperately screaming due to acute and excruciating pain on the right arm and ipsilateral face, described as shock-like and stabbing. Each episode lasted a few seconds but they had been repeating in cluster for over an hour. General blood analyses were unremarkable and the electroencephalography showed a left central frontal rhythmic activity during the pain episodes (fig. 2). The add-on of intravenous lacosamide resolved the painful complaint in a few minutes. The brain MRI performed a few days later showed local tumor recurrence (fig. 2).