A 27-year-old right-handed male presents to the neurology clinic with episodes of “spacing out” and unusual sensations for the past 5 years. The patient describes experiencing brief episodes where he suddenly feels an intense sense of déjà vu followed by a rising sensation in his stomach. These episodes last 30–60 seconds, during which he sometimes notices odd smells that others do not perceive. He then becomes unresponsive for about a minute, staring blankly, and making repetitive lip-smacking movements. His family members have observed these episodes and note that he seems unaware during them. Afterward, he is confused and disoriented for several minutes, sometimes asking repetitive questions. The frequency of these events has gradually increased over the past year, occurring 2–3 times per week. About two months ago, he had a more severe episode where he lost consciousness and experienced generalized convulsions, prompting his visit to the clinic. Past Medical History •Febrile seizures at age 3 •No history of head trauma, stroke, or CNS infections Family History: No known family history of epilepsy Social History •Works as an accountant •No history of alcohol or drug abuse •No known toxin exposures Review of Systems •No headaches, visual disturbances, or focal neurological symptoms •No significant mood changes or psychiatric history Physical Examination •General: Well-appearing male, alert and oriented •Neurological Examination: •Cranial nerves: Intact •Motor and sensory function: Normal •Reflexes: 2+ throughout •Coordination and gait: Normal •No focal deficits Diagnostic Workup 1.EEG: Interictal epileptiform discharges in the left anterior temporal region 2.MRI Brain: shows hippocampal sclerosis 3.Neuropsychological Testing: Impaired verbal memory Which of the following is the most likely diagnosis?
