Chapter

The Boy Who Seized Every Time He Slept

Tobias Loddenkemper and Prakash Kotagal

in A Case a Week: Sleep Disorders from the Cleveland Clinic

Published on behalf of Oxford University Press

Published in print September 2010 | ISBN: 9780195377729
Published online April 2013 | e-ISBN: 9780199322985 | DOI: http://dx.doi.org/10.1093/med/9780195377729.003.0050
The Boy Who Seized Every Time He Slept

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Case 48 introduces a 6-year-old boy who presented for evaluation of seizures which started nocturnally at the age of 4 years, and exclusively nocturnal and occurred only once every few months; medication was not prescribed. At age 5, he developed daytime seizures, which were treated with oxcarbazepine. At age 6 he developed staring seizures, rarely associated with oral and manual automatisms. At around the same time, his seizures increased in frequency to several per day, often causing him to stumble. Both seizure types persisted despite maximum clinically tolerable doses of oxcarbazepine (41 mg/ kg/d). Further antiepileptic drug (AED) trials including levetiracetam, valproic acid and clonazepam failed to improve seizure frequency. Within his first 6 months of life, his parents noted reduced use of the left hand, and his pediatrician found him to have a left hemiparesis and a spastic gait. There was no history of febrile seizures, stroke, cerebral tumor, head trauma, or central nervous system infection. His parents also denied sleep disturbances, including snoring, witnessed apnea, and sleepwalking. Daytime sleepiness that was attributed to AED therapy, as it fluctuated with medication adjustments.

Chapter.  1708 words.  Illustrated.

Subjects: Neurology ; Sleep Medicine

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