Idiopathic generalized epilepsy with typical absences evolving to generalized seizures

This 5.8-year-old boy was assessed following 2 generalized seizures a few days prior to admission. The first event occurred while sitting. He suddenly lifted his right upper limb, his head turned left, his eyes turned upwards, and then his shoulders jerked and he lost consciousness. He was rather hypotonic. Following the brief episode, he was confused and had a frightened look. He was taken to the local hospital where he had a second seizure with vagueness, salivation, and generalized tonic-clonic movements of the extremities. Since those 2 events, the mother had better focused on brief “vacant looks” occurring 4 to 5 times daily that had started since the age of 18 months; she’d previously attributed them to absent-mindedness and tiredness. Note the brief and fragmented generalized spike-and-wave discharges during sleep with no apparent clinical events. During hyperventilation, the brief generalized spike-and-wave discharges were associated with brief staring and impaired awareness. The electroclinical response to sodium valproate was complete. (Contributed by Dr. Athanasios Covanis.)