Childhood absence epilepsy in 7-year-old female (ictal EEG)

(a) Sleep EEG. During sleep, three generalized spike-and-wave discharges of 7.5, 6, and 4 seconds’ duration were recorded. During the 7.5-second 3 Hz generalized spike-and-wave discharge, (a) she slowly opened her eyes wide and had a vague look with concomitant upward tonic spasm of eyebrows for 1.5 seconds; then her eyebrows relaxed to the usual position. Immediately after the discharge, she became conscious for 1.5 seconds and slept again. In a similar discharge of 6 seconds, her eyes slowly opened to a stare, and then her eyes closed immediately after the discharge. During the third discharge (4 seconds), the eyes remained closed. (b) Awake EEG. Hyperventilation while standing: Concomitant with the 3 Hz generalized spike-and-wave discharge, she stopped overbreathing, had a vague look, was not responding, and became slightly unsteady with the body and head bent foreword. Two seconds before the end of the discharge, she scratched her neck with her left hand. Other similar typical absence seizures were recorded during hyperventilation. (Contributed by Dr. Athanasios Covanis.)