Clinical history: A 5-year-old girl was referred to our department for treatment of refractory lateralized status epilepticus (RSE). General history: The child, who had a normal psychomotor development, had experienced focal motor seizures since age 2½ years. EEG showed left centro-parietal spikes, enhanced during sleep. 1.5 T brain MRI was normal. Neuropsychology revealed a normal cognitive level. A diagnosis of benign epilepsy with centro-temporal spikes (BECTS) was made. Examination On admission, the child was treated with intravenous midazolam and valproate. She was sedated, but was able to execute simple orders and to speak. Rightsided focal motor seizures, involving the face and then spreading to the arm and leg, appeared in series of 7-8 attacks per hour. Special studies Prolonged video-EEG monitoring captured seizures characterized by right hemifacial tonic contraction, followed by clonic jerking of the right arm with inconstant involvement of the homolateral leg. The ictal discharge started at the left fronto-temporo-central leads to subsequently involve the contralateral hemisphere. Repeat 1.5 T brain MRI revealed an abnormal gyral pattern, with increased cortical thickness and blurring of the gray-white matter junction, extending from the pole to the central gyrus of the left frontal lobe. Subsequent 3T brain MRI performed 2 weeks after onset of status confirmed the area of structural abnormality and also detected a clear-cut left opercular area of increased signal intensity on T2 and FLAIR-T2-weighted images.
|Title of host publication||Case Studies in Epilepsy: Common and Uncommon Presentations|
|Publisher||Cambridge University Press|
|Number of pages||4|
|ISBN (Print)||9780511706103, 9780521167123|
|Publication status||Published - Jan 1 2012|
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