title: Clinically silent seizures in a neonate with tuberous sclerosis.
abstract: Although seizures during infancy in patients with tuberous sclerosis complex are common, seizures in neonates are infrequent. Here, we report the clinical course and electroencephalography (EEG) findings of a neonate with tuberous sclerosis complex associated with clinically silent seizures. The patient was a girl in whom cardiac tumors were detected on fetal ultrasonography. Brain magnetic resonance imaging during the neonatal period showed subependymal and cortical tubers. Routine EEG indicated unexpected ictal changes with no noticeable clinical symptoms. Ictal EEG was associated with a subtle increase in heart rate and a brief increase in chin electromyogram. These changes were difficult to identify clinically. The patient later developed focal seizures and epileptic spasms and had severe psychomotor delay. The present case suggests the occurrence of clinically silent seizures before the appearance of epileptic spasms in infants with tuberous sclerosis, and that EEG is an option for neonates with a prenatal diagnosis.
authors.affiliation: Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ikeno
authors.affiliation: Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.|Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Okumura
authors.affiliation: Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
authors.forename: Shinpei
authors.initials: S
authors.lastname: Abe
authors.affiliation: Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
authors.forename: Ayuko
authors.initials: A
authors.lastname: Igarashi
authors.affiliation: Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Hisata
authors.affiliation: Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Shoji
authors.affiliation: Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
mesh_terms: D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D012640:Seizures / Q000175:diagnosis / Q000209:etiology*; D014402:Tuberous Sclerosis / Q000150:complications* / Q000175:diagnosis
keywords: clinically silent seizure; ictal electroencephalogram; neonatal seizure; polygraph; tuberous sclerosis