Gyratory Seizures Ataxia And Dysarthria In A Young Adult

A 35-year-old woman had suffered her first generalized tonic convulsion at the age of 9 years when she was in bed soon after falling asleep. One month later, she had another generalized tonic convulsion, and treatment with antiepileptic drugs was started. She developed gyratory seizures several times a day. She was admitted to the epilepsy center at the age of 12 because of status epilepticus. She was ataxic and dysarthric. Five seizures were recorded during routine video EEG monitoring. Her...

Examination and investigations

When we first saw him in February 1998 the patient had a waddling gait. On admission in March 1998, both hips showed signs of the surgical procedures but muscle atrophy was absent. There was no apparent muscular dysfunction, and neurological testing was normal. Laboratory testing revealed reduced serum calcium (1.86mmol 1) and phosphate (0.77mmol l), high alkaline phosphatase (378 U l), high parathyroid hormone (45 pmol l, normal below 6.5 pmol l), and low levels of 25-hydroxy vitamin D3 (5...

Weight Gain Acne And Menstrual Disorder In A Woman With Partial Epilepsy

A 23-year-old woman had several tonic-clonic seizures at the age of 16 and was treated with carbamazepine for some years. Thereafter the medication was tapered off and she remained seizure-free until she started to experience complex partial seizures at the age of 22. Interictal EEG showed paroxysmal slow waves and some sharp waves in the left temporal region. Magnetic resonance imaging of the brain was normal. The patient was considered to have partial epilepsy originating from the left...

New Onset Of Nocturnal Seizures In A 69Year Old

A 69-year-old man experienced three episodes of generalized tonic-clonic seizures that occurred at 3.00 or 4.00 AM, during sleep. The seizures were observed by his wife. His mental status after each seizure was consistent with a postictal state. He had a history of stable asymptomatic coronary artery disease, combined hyperlipidemia, treated hypothyroidism and a mildly increased body mass index of 31 kg m2. He had undergone coronary artery bypass surgery at the age of 62 years but had no...

Unexpected solutions355

90 When antiepileptic drugs fail in an infant with seizures, consider 356 vitamin B6 91 A 12-year-old with daily clonic seizures 359 Eloy Elices and Santiago Arroyo 92 Vigabatrin treatment in a patient with visual field defects what to do 363 Roy Beran 93 A child with attention deficit disorder, autistic features and 366 frequent epileptiform EEG discharges 94 Complete seizure control in a 14-year-old boy after temporal 370 lobectomy failed 95 Ictal crying in a 32-year-old woman 374 Edward B...

The Girl With Visual Seizures Who Wasnt Seeing Things Transient Blindness In A Young Girl

Lauren, a 10-year-old girl, presented with a several month history of episodes that she described as follows 'I see floating colored dots. Then my eyes cross and I suddenly can't see - I just see black in both eyes' (Fig. 39.1). 'I get real scared when things go blank. I feel like I'm in La-La Land.' The first spell occurred a few days after her dog was killed by a car. She had about 30 or 35 spells over the 3 months before presentation at the clinic each spell was identical. The spells lasted...

Treatment and outcome

The boy was treated with a gluten-free diet and carbamazepine 100 mg at bedtime. Three months later, the mother described her son as 'a completely new child'. He was more alert, more pleasant, and had better school performance. The EEG was normal. After having been seizure-free for 1 year, carbamazepine Table 66.1 Laboratory investigations confirming the diagnosis of coeliac disease (glutenenteropathy). In addition, duodenal biopsy showed villous atrophy. Result 8 months Normal values after...

References

Successful treatment of primary reading epilepsy with clonazepam. Ann Neurol 1978 4 155-6. 2. Vanerzant C, Fitz R, Holmes G, et al. Treatment of primary reading epilepsy with valproic acid. Arch Neurol 1982 39 452-3. 3. Valenti MP, Tinuper P, Cerullo A, Carcangiu R, Marini C. Reading epilepsy in a patient with previous idiopathic focal epilepsy with centrotemporal spikes. Epileptic Disord 1999 1 167-71. 4. Pegna AJ, Picard F, Martory MD, et al. Semantically-triggered...

Frequent Night Terrors

A 6-year-old boy was referred because of nightly events thought to be nightmares. These events had started when he was 4 years old and had progressively increased until they happened several times a night. They adversely affected his daytime performance and caused stress in the family. No benefit had been obtained from benzodiazepines or counseling with a behavioral therapist familiar with sleep disorders. His past medical history was unremarkable. There was some relevant family background a...

Examinations and investigations

Periodic Lateralized Epileptiform

On transfer to my ward on day 2 after admission to the emergency department , the patient was stuporous Glasgow coma scale 8 and showed a left sided hemiplegia. A CT scan on admission was unchanged compared with the previous scan performed 2 months ago. Control CT scans performed on the following days also showed no significant changes. A magnetic resonance imaging scan essentially confirmed the CT scan findings. Cerebrospinal fluid showed a mild pleocytosis 14 cells mm3 consisting of...

What did we learn from this case

The anterior cingulate gyrus maintains massive interconnections, both with the limbic system and with the frontal, temporal and parietal neocortex. Therefore, cingulate seizures can have different possible propagation pathways, which may be responsible for the variability of their expression as seizures. Thus patients suffering from cingulate epilepsy can present with findings that are normally associated with epileptogenic foci in different areas of the brain. Ictal symptoms may include, for...

History

A 31-year-old woman suffered head trauma with transient coma at the age of 3 years and developed seizures at the age of 16. The seizures consisted of feeling strange and vertiginous, with a feeling of impending doom, word-finding difficulties, speech perseveration and inability to focus her thoughts. They lasted 4-5 minutes and were followed by drowsiness. They occurred once or twice a month, mostly 2-3 days after the onset of menstruation or at the time of ovulation. Rarely five or six times...

Intriguing causes and circumstances77

20 Abnormal heart rate in a child with West syndrome 78 Julio Ardura and Jesus Andres 21 Hyperactive behaviour and attention deficit in a 7-year-old boy with 81 myoclonic jerks Johan Arends, Albert P Aldenkamp and Biene Weber 22 Seizures with a musical association 86 Tim Betts 23 Temporal lobe epilepsy, loss of episodic memory and depression 89 in a 32-year-old woman 24 Epileptic 'dreamy states' in a young man 93 Warren T Blume 25 Left arm and leg shaking in a patient with a history of treated...

Alternative Therapy For Partial Epilepsy With A Twist

A 20-year-old man presented with a 10-year history of partial seizures that had become generalized. A computed tomography scan of the brain, performed at the onset of the seizures, had shown a lesion, probably a tuberculous granuloma, in the right frontal cortex. He was started on antiepileptic drugs carbamazepine and phenobarbital and given a full course of antituberculous drugs. The seizures were well controlled and after about 5 years, anticonvulsants were discontinued. About 1 year later,...

Commentary

The case illustrates that mediotemporal lobe epilepsy with hippocampal sclerosis may rarely present as an adult-onset disease on the basis of chronic limbic encephalitis. Limbic encephalitis is usually associated with a neoplasia and is then known as paraneoplastic limbic encephalitis. However, cases without neoplasia have been identified in a cohort of patients undergoing presurgical evaluation non-paraneoplastic limbic encephalitis . Limbic encephalitis should be included in the differential...

Boy With Epilepsy And Allergic Rhinitis

A 5-year-old boy with partial epilepsy and allergic rhinitis was hospitalized for optimal seizure control. Eventually, combined antiepileptic treatment with valproate 400 mg 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 mother,...

Man With Shoulder Twitching

A 52-year-old left-handed man presented to the emergency room because of near-continuous twitching of his left shoulder. This shoulder twitching was irregular in frequency, lasted several minutes at a time, and waxed and waned in intensity. The twitching ceased when he was asleep and decreased in intensity when he was distracted. With detailed questioning, the neurology house officer learned that the patient had intermittent twitching of his left calf muscle while gardening 5 days earlier. The...

Examination and

And symmetric deep tendon reflexes, were unremarkable. The observed left shoulder twitching caused his proximal arm to move in an irregular manner. There was no clonic twitching in the proximal or distal arm or hand. The left shoulder twitching ceased when he was asleep or distracted. The twitching increased if he was asked to move his left arm voluntarily. The intensity of the twitching was variable. Suspecting that the events might be non-epileptic, the neurology house officer applied a...

Unforeseen complications and problems275

70 A 35-year-old man with poor surgical outcome after 276 temporal lobe surgery 71 When more is less 279 Carl Bazil 72 Change of antiepileptic drug treatment for fear of side effects 283 in a 45-year-old seizure-free patient 73 Personality and mood changes in a teenager 286 Ahmad Beydoun, Ekrem Kutluay and Erasmo Passaro 74 Monitoring patients may be more important than their 291 laboratory tests 75 Depression in a student with juvenile myoclonic epilepsy 296 Enrique J Carrazana 76 Osteomalacia...