Epileptic nystagmus: description of a pediatric case with EEG correlation and SPECT findings.
Epileptic nystagmus (EN) describes repetitive eye movements that result from seizure activity. We describe a patient with EN and vertigo first noted at the age of 4 yr and 10 mo. Brain MRI did not show anomalies. Ictal EEG recordings revealed epileptic activity during three episodes of horizontal, left-beating nystagmus not crossing the midline. Ictal 99mTc-ECD SPECT demonstrated the presence of active foci in multiple cerebral regions including bilateral prefrontal, bilateral parieto-temporo-occipital and the left parieto-insular-vestibular areas. A wide area of hypoperfusion was also evident in the right hemisphere, prevailing in the parieto-occipital regions and the medial prefrontal gyrus. Topiramate was started at a dose of 2 mg/kg/d with complete seizure control after 14 d. EEG and SPECT were repeated after a seizure-free period of 1 mo; disappearance of epileptic activity and modification of cerebral perfusion were evident. This case reaffirms the cortical origin and involvement of temporo-occipital and frontal cortex in the genesis of saccadic epileptic nystagmus. Rapid complete control of clinical events coincided with the normalization of EEG and improvement of the SPECT pattern.
Nicita
F
F
Department of Pediatrics, Child Neurology Division, Sapienza University of Rome, Rome, Italy.
Papetti
L
L
Spalice
A
A
Ursitti
F
F
Massa
R
R
Properzi
E
E
Iannetti
P
P
D001921:Brain / Q000000981:diagnostic imaging; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology; D002675:Child, Preschool; D003545:Cysteine / Q000031:analogs & derivatives; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D009759:Nystagmus, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D012640:Seizures / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon; D014717:Vertigo / Q000150:complications; D014787:Vision Tests
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine