title: Wicket spikes misinterpreted as focal abnormalities in idiopathic generalized epilepsy with prescription of carbamazepine leading to paradoxical aggravation.
abstract: Wicket spikes (WS) are a normal variant EEG pattern that sometimes can be mistaken for epileptiform activity. We present a patient with WS and idiopathic generalized epilepsy who had been wrongly diagnosed with focal epilepsy, which leads to the prescription of carbamazepine with severe aggravation of generalized tonic-clonic seizures. She was referred for presurgical assessment of refractory focal epilepsy but long-term video-EEG showed sharp theta waves over the temporal regions during awakening, with a typical aspect of WS during drowsiness, nREM sleep stages I-II, and rapid eye movements (REM) sleep. There were a few generalized spike-waves during sleep but interictal changes were increased in frequency at awakening with bursts of fast-generalized spike-waves. Carbamazepine was progressively withdrawn and the patient was progressively switched to zonisamide. The patient no longer complained of generalized tonic-clonic seizures. At one year follow-up, this patient receives zonisamide with valproate. She has remained seizure-free.
authors.affiliation: Unité médicochirurgicale de l'épilepsie, Montpellier, France. a-crespel@chu-montpellier.fr
authors.forename: A
authors.initials: A
authors.lastname: Crespel
authors.forename: R
authors.initials: R
authors.lastname: Velizarova
authors.forename: P
authors.initials: P
authors.lastname: Genton
authors.forename: P
authors.initials: P
authors.lastname: Coubes
authors.forename: P
authors.initials: P
authors.lastname: Gélisse
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use; D002220:Carbamazepine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000078306:Clobazam; D002998:Clonazepam / Q000008:administration & dosage / Q000627:therapeutic use; D003951:Diagnostic Errors; D004359:Drug Therapy, Combination; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis; D004830:Epilepsy, Tonic-Clonic / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D012074:Remission Induction; D012894:Sleep Stages / Q000502:physiology; D013702:Temporal Lobe / Q000503:physiopathology; D013826:Theta Rhythm; D000077236:Topiramate; D014635:Valproic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D000078305:Zonisamide
chemical_list: D000927:Anticonvulsants; D007555:Isoxazoles; D000077236:Topiramate; D001569:Benzodiazepines; D000078306:Clobazam; D005632:Fructose; D002220:Carbamazepine; D000078305:Zonisamide; D002998:Clonazepam; D014635:Valproic Acid