An eight year old girl was brought to the office for neurologic evaluation following several episodes characterized by staring, asymmetric facial grimace, and production of guttural noises lasting about 1 minute. Following each event, the patient was lethargic for several minutes and on several occasions seemed to exhibit right facial paresis. The patient was had no memory of the events themselves, but could recall a vague taste of plastic in her mouth just preceding onset of symptoms.
The patient's past medical history was unremarkable save for premature birth at 32 weeks gestation with a 3 week postnatal hospitalization for feeding and respiratory problems. Developmental milestones were normal. Review of the family history revealed that the patient's mother and aunt had suffered from febrile seizures as infants, although no close relatives suffered from epilepsy.
On exam, the patient was alert and appeared well. Her weight, height, and head circumference all ranked near the 50th percentile for age. General exam showed no signs of a neurocutaneous disorder. Neurologic examination was entirely within normal limits for age, including funduscopic exam.
MRI of the brain with and without gadolinium contrast was normal. An awake and asleep EEG revealed frequent spike-wave discharges emanating from the left hemisphere on referential montages and localized to the left tempral lobe near the T3 electrode on bipolar montages.
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Created: July 25, 1995