Eyelid myoclonia and absences in a 13-year-old girl (EEG)

EEG during intermittent photic stimulation of a 13-year-old girl with a 6-month history of facial grimace-like movements occurring daily, which were considered tics. Two weeks prior to being seen, she had a generalized tonic-clonic seizure and was given carbamazepine by her doctor. Her facial movements deteriorated, and this was attributed to her increased anxiety following the generalized seizure. Routine initial evaluation revealed eyelid jerks and absences on eye closure. Carbamazepine was discontinued, and a sleep-awake video-EEG was arranged after sleep deprivation. The EEG showed the characteristic electroclinical picture on eye closure, with some concomitant head jerk movements and photosensitivity. The repetition of discharges during the same flash rate as shown on EEG led to confusion and poor response to verbal stimulus. The procedure was stopped, and rectal diazepam was given to prevent a generalized seizure. (Contributed by Athanasios Covanis MD PhD.)