Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Convulsive syncope then convulsive seizure occurred in the long clinical course: a case report

Kozue Sakakibara-Hayashi, M.D.1), Takeshi Inoue, M.D.2)5), Ichiro Kuki, M.D., Ph.D.2), Masakatsu Usui, M.D.3), Akio Ikeda, M.D., Ph.D.4)5) and Masutaro Kanda, M.D., Ph.D.4)

1) Department of Neurology, Kyoto University Graduate School of Medicine
2) Child and Adolescent Epilepsy Center, Pediatric Neurology, Osaka City General Hospital
3) Department of Emergency, Uji-Tokusyukai Medical Center
4) Department of Neurology, Ijinkai Takeda General Hospital
5) Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine

A 17-year-old woman presented with transient consciousness impairment attack and convulsion after bathing and prolonged standing since age 12. EEG showed WHAM ( wake, high amplitude, anterior, male) type of phantom spikes that usually carry the high risk of epilepsy at age 13. At age 17, EEG wise generalized spike and wave complex was recorded once, and head-up tilt test was positive. She was carefully observed without antiepileptic drugs since convulsive syncope due to neurally mediated syncope was most likely. During the follow-up period, she had eventually unprovoked generalized tonic-clonic seizures (convulsive seizure) twice and thus she was started with antiepileptic drug with success. Although both convulsive syncope and convulsive seizure differ in nature and effects on quality of life, in this patient, the latter occurred later and both occurs together. It is important to distinguish them by means of the degree of convulsion and EEG finding.
Full Text of this Article in Japanese PDF (1326K)

(CLINICA NEUROL, 60: 627－630, 2020)
key words: transient consciousness impairment attack, neurally mediated syncope, convulsive syncope, convulsive seizure, phantom spike and waves

(Received: 20-Mar-20)