Juvenile myoclonic epilepsy in a patient with history of infantile hemiplegia

Introduction

The 1989 International Classification of Epilepsies and Related Syndromes considers normal cognitive, neurologic and anatomic findings to be prerequisites for the diagnosis of idiopathic forms of epilepsy.

Case report

We report the case of a woman with juvenile myoclonic epilepsy (JME) and a history of infantile hemiplegia. When she was a teenager, she had two generalized tonic-clonic seizures, later followed by a few seizures with loss of consciousness misinterpreted as complex partial seizures. Physical examination revealed right hemiparesis. A CT scan documented a left rolandic infarction and a wrong diagnosis of focal epilepsy was made. At 20 years, a nap video-EEG was performed. A burst of generalized spike-waves was recorded on awakening. Photic stimulation and watching a Japanese cartoon on television disclosed a marked photoparoxysmal response associated with myoclonic jerks. Myoclonic jerks were in fact known by the patients but unreported. She had jerks on roads with trees due to shade/sunlight alternance. A diagnosis of JME was made.

Conclusion

This observation illustrates that patients’ situation with a presumed genetic predisposition for JME are at equal risk for brain lesions as others subjects. Misdiagnosis of focal epilepsy may have dramatic consequences in patient with JME, as some patients will be aggravated by inadequate antiepileptic drugs.