A 14 year old girl was brought to clinic for evaluation of several brief, generalized seizures which occurred during awakening from sleep. The seizures consisted of bilaterally symmetric tonic-clonic activity lasting 2 minutes accompanied by incontinence but no lateralizing features. Following each episode, the patient was unarousable for several minutes and regained normal alertness only after sleeping for several hours.
The patient's past medical history was significant for a single febrile seizure at 15 months and early language delay with subsequently normal development (the patient maintaining an A-B average in a regular 8th grade program). Family history was pertinent insofar as a second cousin was thought to suffer from absence epilepsy.
Neurologic review of systems revealed that the patient had experienced sudden jerking movements of one or both arms on numerous occasions during the prior year, often of sufficient force to cause her to lose grip of objects held in her hands. In addition, a few spells of brief staring and lip quivering had been witnessed by family members.
General physical and neurologic examinations were entirely normal. Sixty seconds of hyperventilation failed to precipitate staring or other symptoms of seizure.
MRI of the brain with and without gadolinium contrast was normal. A sleep-deprived EEG revealed paroxysmal runs of generalized-onset 4 cycle per second spike and wave activity periodically interrupting otherwise normal background activity.
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Created: July 25, 1995