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Epilepsy and Seizures

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A 9-year-old boy is brought to your clinic by his parents because he has begun to have episodes of eye fluttering lasting several seconds. Sometimes he loses track of his thoughts in the middle of a sentence. There was one fall off a bicycle that may have been related to one of these events. There are no other associated symptoms, and the episodes may occur up to 20 or more times per day. The boy's development and health have been normal up until this point. He had two head injuries as a young child: the first when he fell off a tricycle onto the ground, and the second when he fell off a playset onto his head. Both episodes resulted in a brief loss of consciousness and he did not think clearly for part of the day afterward, but he had no medical intervention. Which of the following test results is most likely?

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a. Electroencephalogram (EEG) showing 1 to 2 Hz spike wave

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b. Brain magnetic resonance imaging (MRI) showing widespread abnormalities

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c. EEG showing 2 to 3 Hz spike wave

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d. Lumbar puncture with high white blood cell (WBC) count

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e. Conners Rating Scale abnormalities reported by parents, but not teachers

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The answer is c. This is a common presentation for primary generalized epilepsy of childhood. An EEG showing the classic 3-Hz spike-and-wave pattern would confirm this diagnosis. 1 to 2 Hz would be consistent with severe neurological dysfunction and symptomatic generalized epilepsy. Brain MRI would be normal or show an incidental finding. Anatomic problems can cause seizures, but these tests will not provide any information about brain electrical activity. Lumbar puncture is useful for measuring cerebrospinal fluid (CSF) pressure and looking for central nervous system (CNS) inflammation or infection. CNS inflammation or infection may cause seizures. Conners Rating Scale is useful for the evaluation of inattention and hyperactivity.

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A 19-year-old right-handed man who carries the diagnosis of epilepsy is seen in the urgent-care clinic. He had been healthy until about age 12, when he began to have episodes of eye fluttering lasting several seconds. Sometimes he would lose track of his thoughts in the middle of a sentence. There was one fall off of a bicycle that may have been related to one of these events. He has been treated with valproic acid. At one point he was off all medications, but the seizures returned. He is now at the end of his first semester of college and came in today because he had witnessed generalized tonic-clonic seizure this morning. He had had only about 2 hours of sleep the night before because he was ...

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