Electronic ISSN 2287-0237
Typical Clinical Scenarios
Case 1: A 15-year-old high functioning autistic boy with normal IQ was found to have episode of eyes rolling upwards followed by rhythmic body shaking and was unresponsive for 2 minutes. Ten hours after symptom onset, EEG study was performed and reported as normal . One week later, during playing soccer, he had another attack with similar pattern. Physical examination was unremarkable. Second EEG study was normal. He has no history of head injury. Family history was negative for seizure disorder. No developmental regression is mentioned. Should we prescribe antiepileptic drugs for this child?
Case 2: A 7- year 2-month-old autistic girl with severe develop- mental delays who has developed ‘bizarre behaviors’ described as head nodding and rapid eye blinking during listening to radio over a two week period. During sleep, she sometimes wakes up in the middle of the night and makes loud noises for 10 minutes before falling asleep again. These behaviors are unusual and have never occurred before. Regular medications included risperidone, methyl- phenidate, and zinc supplements. Are those ‘bizarre, unusual behaviors’ epilepsy or just stereotypic movements that are commonly found in autistic children?
Case 3: A 5-year-old autistic girl with epilepsy. Her seizures (generalized tonic-clonic) are well-controlled by valproic acid. She has had regular rehabilitation and physical therapy for motor and speech delay. Overall milestones are gradually improved. One day after being rebuked by a friend at school, she stopped speaking, not making any sound. However, she is able to follow verbal instruc- tion as usual. Parents are frightened and bring her to pediatrician for proper opinion. Has she developed language regression? Could this symptom be a subclinical seizure or just a behavioral reaction?
Case 4: A 10-year-old high functioning autistic boy is brought to clinic due to excessive drowsiness over two weeks. Actually his sleep duration is usually of 6-8 hours a day but has increased to 12-16 hours a day. Teachers have also reported to parents regard- ing his frequent falling asleep in the classroom. Normally, he is a good disciplined child and is always admired by parents, teachers and friends. Academic performance is average. He is a school tennis athlete. There is neither fever, history of head injury nor drug use during this episode. Physical examination is normal. Blood tests for CBC, electrolytes, sugar, BUN, Cr, liver function, thyroid function, and ammonia level are normal. CT scan of the brain shows negative study. Shall we consider ‘non-convulsive seizure’ as the cause of excessive sleepiness in this patient?
