A 21-year-old right-handed woman was seen in the outpatient department of an epilepsy centre 1 week after a generalized tonic-clonic-seizure.
The report from the emergency room described tongue biting, and I got an unequivocal description of a generalized tonic-clonic seizure from the patient's mother. The seizure happened 1 hour after awakening. She had not slept adequately for several days because she was studying for an examination.
I asked them about a previous history of other seizures and epilepsy, which both she and her mother denied strongly. Then I discussed specific signs and symptoms of seizures. When I demonstrated jerks with my arms and shoulders, the patient told me that this was very familiar to her and that she often had similar jerks in the morning, dating back to when she was aged 12 or 13.
However, these jerks, in her mind, had nothing to do with her seizure. To her, they were just a personal mode of behaviour. Her mother admitted to having the same problem beginning in her school years, which she described as 'funny jerks'. She strongly denied having any 'blackouts'. Doctors, she noted, had explained the jerks as just tics. She had been satisfied with this explanation, because her aunt was also reported to have these 'funny jerks'. It seemed that in this family, to some extent, jerks were acceptable behaviour in the women.
Physical and neurological examinations were normal. A magnetic resonance imaging scan showed slight frontoparietal parasaggital atrophy. The routine EEG showed increased generalized intermittant rhythmic slowing that was excessive for her age. With sleep deprivation, bilateral polyspike-and-wave complexes were seen, which were intermittently accompanied by bilateral myoclonic jerks of the upper extremities.
An EEG of the mother was obtained, which showed increased generalized
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