Case Report of Rasmussen's Encephalitis With a Decade of Refractory Epilepsy and Hemispheric Atrophy

Rasmussen's encephalitis (RE) is a rare, chronic inflammatory neurological disorder affecting one cerebral hemisphere and presenting with drug-resistant epilepsy, progressive hemiparesis, and cognitive decline. This case report describes the clinical course and management of a 21-year-old patient with refractory epilepsy and progressive neurological deterioration due to RE, followed over 12 years. The patient initially presented with persistent focal seizures characterized by automotor features, visual hallucinations, and postictal confusion, along with progressive right hemispheric atrophy and metabolic disturbances, including hypokalemia and bicarbonate deficits. Diagnosis was established through neuroimaging, revealing significant right hemispheric atrophy and EEG findings of frequent multifocal discharges. Management included immunomodulatory therapies, surgical intervention (right temporal lobectomy), and antiseizure medications. Despite partial seizure control, disease progression could not be arrested.