Abstract
A nine-year-old boy experienced recurrent episodes of impariment of consciousness accompanied by oral automatism and fine rhythmic movements of toes. rIctal EEGs were composed of three different patterns as follows:
1) Rhythmic high voltage slow wave bursts which are often accompanied by small spikes.[Type A]
2) Symmetrical generalized 3 c/sec spike and wave complex preceded by right midtemporal-occipital slow wave bursts.[Type B]
3) Symmetrical generalized 3 c/sec spike and wave complex preceded by very short duration of mid-temporal spikes, not preceded by slow wave bursts. This 3 c/sec spike and wave complex is not terminated abruptly.[Type C]
From the above-mentioned ictal EEG patterns and their corresponding clinical symptoms, this boy is diagnosed as having both complex partial seizure in type A ictal EEG and seizure with secondary bilateral synchrony in type B ictal EEG which slightly resembles absence seizure. But an attack showing type C ictal EEG is difficult to classify. According to the previously reported facts that include the differential diagnosis of absence and complex partial seizures, this seizure is compatible with absence seizures. But considering that this boy was diagnosed as complex partial seizure in type A ictal EEG and a seizure with secondary bilateral synchrony in type B ictal EEG, and phenytoin monotherapy was effective, an attack showing type C ictal EEG should be classified as one indused by secondary bilateral synchrony.
