Why has demonstration of the epileptic nature of this nocturnal bizarre dyskinesia proved to be such a hard task

As mentioned in the section 'Introduction', ever since Lugaresi et al. described the episodes of dystonic and dyskinetic movements occurring out of NREM sleep (NPD), whether they were arousal disorders (parasomnias) or epileptic seizures has been controversial. In favor of the former were first, the intriguing lack of clear EEG discharges between and during attacks second, the occasional coexistence of the most striking event (NPD) with phenomenologies whose semiology could be considered more...

Status Epilepticus in a Heavy Snorer

Peter Hollinger, Christian W Hess and Claudio Bassetti A 50-year-old railwayman suffered from idiopathic absence seizures until the age of 16 years and had been seizure-free without antiepileptic treatment since then. Hypothyroidism and arterial hypertension were adequately treated. He was a heavy, habitual snorer. His wife witnessed nocturnal apneas and he reported excessive daytime sleepiness (e.g. falling asleep when watching television or when traveling in the train, or in the car as a...

Abulia in a Seizure Free Patient with Frontal Lobe Epilepsy

Ennapadam S Krishnamoorthy and Michael R Trimble A 32-year-old medically retired civil servant was referred to our clinic by his general practitioner. He had a history of epilepsy from the age of 16 years, and 3 years earlier, on referral to a university hospital, he had been correctly diagnosed with frontal lobe epilepsy. Neuroimaging studies had shown right frontal pathology. Therapy with topiramate had been instituted, which led to complete cessation of seizures. However, over the 18-month...

Boy with Epilepsy and Allergic Rhinitis

A five-year-old boy with partial epilepsy and allergic rhinitis was hospitalized for optimal seizure control. Eventually, combined antiepileptic treatment with valproate 400mg day, zonisamide 80 mg day, and clonazepam 0.8 mg day resulted in complete seizure control. About 6 months later, he was given ketotifen 1.0 mg day for treatment of allergic rhinitis. A few days later, he started having partial seizures, with or without loss of consciousness, two or three times a day. According to his...

References

Venkataraman V Wheeless JW Safety of rapid intravenous infusion of valproate loading doses in epilepsy patients . Epilepsy Res 1999 35 147 53 . 2. Kaplan PW Intravenous valproate treatment of generalized nonconvulsive status epilepticus . Clin Electroencephalogr 1999 30 1-4 . 3. Chez MG, Hammer MS, Loeffel M , Nowinski C , Bagan BT. Clinical experience of three pediatric and one adult case of spike-and-wave status epilepticus treated with injectable valproic acid . J Child Neurol 1999 14 239-42...

Treatment And Outcome

Following the episode of status epilepticus, it was determined that long-term phe-nytoin was necessary. He was therefore discharged on phenytoin 300 mg daily and did well for the next 3 months. He attended Alcoholics Anonymous and remained free of further seizure activity. On two office visits 6 weeks apart, the patient had a normal examination, including a normal cognitive status. The patient then began having right arm tremor associated with an altered state of consciousness and loss of...

Patient with Epilepsy Slips Down Some Attic Stairs

A 63-year-old white man was admitted to a community hospital with status epi-lepticus and then transferred to my facility the next day for further evaluation and management. The patient had a history of seizures since the age of 16 (etiology and type unknown) and had been well controlled on phenobarbital and phenytoin since then. His seizures consisted of arm and leg shaking with loss of consciousness and occasional incontinence. Six months before admission, he slipped down some stairs and...

Diagnosis

Psychogenic disorder DSM-IV 299.80 and mental retardation DSM-IV 319 epilepsy with myoclonic astatic seizures. Actually, after the last MRI the diagnosis of epileptic disease may be reviewed. Before we considered this patient as affected by a generalized epilepsy with myoclonic astatic seizures. Now we believe that this patient has a focal frontal lobe epilepsy with severe evolution into a kind of epileptic encephalopathy with bilateral synchrony and myoclonic astatic seizures. We also think...

A 12Year Old Boy with Daily Clonic Seizures

A 12-year-old right-handed boy started to have seizures at the age of 5. At first the seizures consisted of clonic jerking of the left lower extremity, most prominent in the foot. Within a few weeks, the seizures evolved into epilepsia partialis continua, which was eventually controlled, several months later, on a combination of carbamazepine and clobazam. Soon after this, the patient started to have daily clonic seizures of his left lower extremity again most prominent in the foot left-sided...

Examination And Investigations

Clinical examination revealed no pathological findings. Neuropsychological examination found verbal and visual memory deficits and cognitive deficits. Several EEGs demonstrated diffuse slowing and intermittent theta-wave activity in the left fronto-temporal region. Magnetic resonance imaging scanning demonstrated gliosis in the left posterior cruz. After withdrawal of his antiepileptic drugs, two seizures were recorded with video EEG monitoring. The first event occurred while the patient was...

Commentary

This case is remarkable for several reasons. First, this patient demonstrates the deleterious effects of a failure of seizure-terminating mechanisms.2 From our clinical experience we are confident that most seizures will stop spontaneously without medical intervention.3'4 The development of status epilepticus in patients with chronic epilepsy actually is a rare event, usually is ascribed to special circumstances including noncompliance with antiepileptic medication, alcohol intake, or acute...

Vitamin B6

A 3 -year-old girl had a normal perinatal history, normal growth and development, and a negative family history. She first presented at 8 months of age with partial seizures involving the left hand and arm. A routine EEG and a video EEG, without an event, were normal, as was a magnetic resonance imaging MRI scan of the brain. She was treated with carbam-azepine and was seizure-free for 2 months. She then presented with partial motor seizures, which again began in the left hand but then...

Emilio Perucca

Carreno is remarkable in at least two aspects i the refractoriness to several AEDs of a syndrome that usually responds well to treatment and ii the fact that seizure control was eventually achieved on a complex polytherapy, although it remains unclear whether the same effect could have been achieved by stabilizing the patient on zonisamide alone. From a preclinical perspective, a question relevant to this case is whether experimental tools are available that allow us...

Stephen C Heinrichs

Sudden, irregular movements of the face, limb, or whole body mimicking epileptic seizures can be readily induced in normal, non-human animals without presupposing either a history of or genetic predisposition for convulsive behaviors. The fact that stressor exposure is a reliable trigger in animals for non-epileptic convulsions allows such noxious stimuli to be employed in the modeling of the psychogenic seizure phenomenon, and to serve as effective tools for probing the neural mechanisms of...

Further Reading

Angell M , Kassirer JP Alternative medicine, the risks of untested and unregulated remedies . N Engl J Jonas WB . Alternative medicine learning from the past, examining the present, advancing to the future . Psychology Treats Epilepsy advertisement . Times of India. Mumbai, 14 June 1998 3. A 19-Year-Old Man with Epilepsy, Aphasia, and Hemangioma of the Cranial Vault

A normal MRI study

A positive family history of seizures or primary RE, or both, is another common feature of this disorder.9'10 In some cases, but not all, jerks are associated with spikes, sharpened elements, and paroxysmal rhythmical delta activity over the dominant tempo-roparietal region. Moreover, recent work with fMRI suggests that RE is a focal epilepsy, but one in which subcortical structures are recruited during epileptiform discharges.11 Although spontaneous remission is unlikely, these cases respond...

Investigations

Mesio Temporal Lobes

On neuropsychological investigation, the child proved to have good attention. The Wechsler Intelligence Scale for Children version III disclosed clear dissociation between verbal abilities a score of 56 and non-verbal abilities a score of 90 . There were phonological defects and articulation troubles. The Chevrie Muller test revealed major difficulties in repetition of simple words as well as dyssyntaxia. Naming remained difficult, with phonemic paraphasias. In addition, memory for both verbal...

Invasive LTM

Strip Invasive Eeg

FIGURE 90.2 Shows a diagram of the subdural grid and strips for the invasive LTM. Rt. anterior Rt. posterior interhem. strip interhem. strip FIGURE 90.2 Shows a diagram of the subdural grid and strips for the invasive LTM. Generalized ballistic tonic dystonic movements FIGURE 90.3 These figures illustrate three EEG epochs occurring in this and other typical clinical attacks. In a note the abrupt onset, during NREM sleep, of a train of about 6 7 Hz spikes originating very focally from the right...