Monthly Case

A 15-year old male adolescent is admitted to our clinic to clarify if paroxysmal episodes with loss of consciousness and subsequent fall can be attributed to epileptic seizures or to seizures of other origins. Other seizures comprise syncopes or – very rare – cataplectic seizures that are part of narcolepsy. The patient himself was not able to give too many details on the seizures, as he was amnesic for most parts of it.

In our clinic, all patient rooms, corridors, and recreation rooms have fixed video cameras which allow for recording and post-hoc analysis of seizures. At the beginning of this patient’s first seizure in our clinic, he stood at the window of this room drinking some water out of a bottle. After some seconds, his hand holding the bottle slipped downwards, the patient staggered, and eventually fell backwards to the bottom in a flabby manner. Again some seconds later he had a generalized tonic posturing which evolved to bilateral clonic movements. Postictally, the patient is disorientated for another 20 min. In summary, this event unequivocally was an epileptic generalized tonic clonic seizure. In the further course of our diagnostic procedures incl. video-EEG-monitoring, the diagnosis of juvenile myoclonic epilepsy was made. It was somewhat irritating that at the onset of the seizure the muscle tonus was flabby; this rather points to syncope. On the other hand, videographic analyses on induced syncopes in healthy subjects have demonstrated that at the onset the whole body can express a tonic posturing.

This case example may illustrate that single clinical signs are never sufficient to allocate seizures correctly. Rather, the entire clinical scenario has to be considered.

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