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092 The rare case of praxis and thinking reflex epilepsy
  1. Alexandra Zirra1,2,
  2. Meneka Sidhu1,2
  1. 1National Hospital of Neurology and Neurosurgery
  2. 2Chalfont Centre for Epilepsy

Abstract

Background We report a rare case of reflex epilepsy in a 36-year-old female who was initially diagnosed with juvenile myoclonic epilepsy (JME).

Case Presentation Aged 15, spontaneous left sided myoclonic jerks and rare generalised tonic clonic seizures (GTCS) began. JME was diagnosed then, based on generalised spike wave discharges.

As GTCS occurred once a year, she opted against treatment. Aged 26, due to seizure exacerbation, levetiracetam was commenced with complete seizure cessation.

Aged 34, ascending electric-shock-like sensations from her feet with myoclonic jerks occurred exclusively whilst performing or even thinking about specific tasks such as hair brushing and complex arithmetic. No spontaneous seizures occurred. She was diagnosed with anxiety and referred to the epilepsy clinic at NHNN.

Borderline hypothyroidism was diagnosed 6 months prior to symptom onset and treated with levothyroxine. There was otherwise no change in behaviour or cognitive function.

On video-telemetry habitual reflex events were preceded by brief bursts of predominantly left fronto-central spike-and-slow wave complexes. Inter-ictally there were independent left central spike-wave-complexes suggesting a left fronto-central focal reflex epilepsy syndrome.

Levetiracetam was optimised and lamotrigine commenced with complete cessation of seizures.

Conclusion It is important to recognise reflex epilepsy syndromes, rare entities, as they are frequently misdiagnosed.

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