A 6 year old boy was brought to clinic for evaluation of inattention and staring first noted by his teachers in school. Several instructors described unusual spells of staring lasting several seconds which were sometimes accompanied by brief fluttering of the eyelids. Although the child was described as "bright", he frequently lost focus during classroom activities and required frequent redirection. In retrospect, the boy's mother recalled similar symptoms seen at home, beginning at age 5.
The child's past medical history and early developmental milestones were otherwise unremarkable. Family history was negative for epilepsy or other neurologic problems.
General physical examination was normal and no signs of a dysmorphic or neurocutaneous disorder were evident. Neurolgic examination revealed normal function of cranial nerves II-XII (including funduscopic exam) and unremarkable testing of strength, sensation, and coordination. Deep tendon reflexes were 2+ throughout and no Babinski sign could be elicited.
Thirty seconds of hyperventilation precipitated a 5 second episode of eyelid fluttering and unresponsiveness with immediate return to normal consciousness afterwards. The patient had no recollection of words spoken to him during the episode.
Contrasted MRI of the brain was normal. EEG revealed several 3 to 8 second runs of generalized 3 cycle per second spike and wave activity with apparent precipitation during hyperventilation.
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Created: July 25, 1995