Typical absence seizures with continuous and repetitive myoclonic jerking of the eyebrows

(First and second absence seizure) These occurred during hyperventilation with breath-counting and with eyes closed. Eyes open and counting is interrupted within the first two seconds of the onset of 2.7-Hz generalized spike-wave discharges. There is severe impairment of consciousness with consistent eyebrow rhythmic myoclonus. Note marked tongue automatisms and vocalizations. She recovers from total unresponsiveness immediately with the termination of the ictal discharge. (Third absence seizure during sleep) In sleep, there were brief generalized bursts of spikes and multiple spikes as well as focal sharp waves occurring independently on both sides of the anterior brain regions. A typical absence seizure was recorded. The girl wakens, opens her eyes, and has some mild automatisms during the ictal discharge. (Used with permission from: Panayiotopoulos CP. Perioral myoclonia with absences. In: Panayiotopoulos CP, editor. The Epilepsies: Seizures, Syndromes and Management. Oxford: Bladon Medical Publishing, 2005:324-7.)