Dados do Trabalho

Título

PAROXYSMAL TONIC UPGAZE MIMICKING OCCIPITAL EPILEPSY

Apresentação dos casos

A 1-year and 6-month-old boy, presented with episodes of upward eye deviation. Born full-term via elective cesarean section, with an Apgar score of 10/10, normal neuropsychomotor, and unremarkable familial and personal medical history. These episodes began at 1 year and 5 months of age, lasting 10 seconds, and occurred more than 100 times per day. During these episodes, the child remained conscious, maintained posture, and exhibited downward head movements. Valproic acid was initially effective but soon, the seizures resumed. Levetiracetam was prescribed but discontinued due to irritability.
He was managed with valproic acid, transitioning to carbamazepine and clobazam. A Video-EEG showed an organized baseline rhythm in the posterior regions (theta-alpha 7-9Hz, irregular and symmetrical, with attenuation upon bilateral eye-opening) and rare slowing over the left parieto-occipital region. The interictal activity showed rare epileptiform paroxysms in the centrotemporal and left occipital regions. Several episodes of upward eye deviation and slight head drop were recorded without corresponding EEG changes.
Antiepileptic medications were gradually discontinued, and the episodes ceased after three weeks. The child has remained episode-free and is developing normally two years later. He remains with no further episodes and with normal development two years later.

Discussão

Paroxysmal tonic upgaze (PTU) is a benign, non-epileptic disorder seen in childhood [1]. It presents sustained upward eye deviation, neck flexion, and downward saccadic eye movements, preserved horizontal eye movements, and no loss of consciousness [2]. PTU is often mistaken for seizures due to the similarity in symptoms. However, unlike seizures, PTU typically shows normal EEG findings [3]. The condition is self-limiting [4]. Despite being uncommon, epileptiform paroxysms were observed in the present case VEEG; however, the discharges were interictal.

Comentários finais

PTU is an important confounder of epilepsy, especially when interictal electroencephalographic discharges are present. VEEG can be significant for distinguishing between seizures and non-epileptic events [2].

Referências

[1] Ouvrier RA, Billson F. Paroxysmal tonic upgaze of childhood - a review. Brain Dev 2005;27:185e8.
[2] Salmina, C., Taddeo, I., Falesi, M., Weber, P., Bianchetti, M. G., & Ramelli, G. P. (2012). Paroxysmal tonic upgaze in normal children: A case series and a review of the literature. European Journal of Paediatric Neurology, 16(6), 683–687. doi:10.1016/j.ejpn.2012.04.004
[3] Ouvrier RA, Billson F. Benign paroxysmal tonic upgaze of childhood. J Child Neurol 1988; 3: 177–180. DOI: 10.1177/088307388800300305.
[4] Zhang YF, Wang YZ, Hao XS, Zhang HB, Wang JT, Liang JM. Paroxysmal tonic upgaze accompanied by occipital discharge on electroencephalography: a case report and literature review. J Int Med Res. 2021 Feb;49(2):300060520984929. doi: 10.1177/0300060520984929. PMID: 33530807; PMCID: PMC7871064.

Palavras Chave

Paroxysmal tonic upgaze; PTU; occipital epilepsy