We report an 18 year old patient with right frontal lobe epilepsy due to paramedian focal cortical dysplasia (FCD). The patient’s usual seizure semiology consisted of a somatosensory aura of the left hand followed by a tonic seizure of the left arm which evolved to a bilateral asymmetrical tonic seizure without loss of consciousness. In the two years preceding the study (see below) he had rare night-time seizures only. His antiepileptic medication consisted of levetiracetam 500 mg, phenobarbital 25 mg, and carbamazepine 1600 mg daily. During presurgical videoelectroencephalogram (video-EEG) monitoring, interictal EEG showed right frontotemporal spikes. Ictal EEG revealed seizure patterns with a right frontal onset. Magnetic resonance imaging (MRI) showed FCD in the right superior frontal gyrus extending into the right precentral gyrus (fig 1A). Neurological examination was normal.