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Abstract: A 15-year-old boy suddenly developed facial convulsions, drooling, and loss of consciousness shortly after going to bed, but regained consciousness after rest, but was unable to recall the symptoms of period onset. For further treatment, he came to our hospital and was given a CT examination of the patient’s head, which showed no significant abnormalities. The EEG showed that the patient had frequent spike waves in the left central and temporal regions, and was diagnosed as benign epilepsy with spike waves in the central region. In view of the patient’s first seizure, the patient was given close observation, and fortunately, no convulsions occurred.
Basic information】Male, 15 years old
Type of disease】Benign epilepsy (benign epilepsy with central temporal spike waves)
Hospital】Beijing Tiantan Hospital
Date of consultation】July 2019
Treatment plan】Close observation
Treatment Period】1 year of outpatient follow-up
Treatment effect] No convulsions occurred
I. Initial interview
The patient was a 15-year-old high school student who was led to the clinic by his parents. Upon inquiry, we learned that the patient suddenly developed facial twitching and drooling shortly after going to bed yesterday, accompanied by tonicity and convulsions of the limbs, loss of consciousness and failure to respond to calls, and recovered consciousness after 5 minutes of rest, but could not recall the symptoms at the onset. After the patient was awake, he felt that his tongue was stiff and he had difficulty speaking, and his symptoms were completely relieved the next day. The parents were very worried and came to our hospital for further treatment.
According to the patient’s symptoms, a CT examination of the head was performed, and no significant abnormalities were found. He had no family history of hereditary disease, infectious disease, heart disease, diabetes mellitus, no major surgery, and no history of drug allergy.
II. Treatment history
To clarify the diagnosis, the patient was given further physical examination. The patient was breathing 17 times/minute, blood pressure 115/60 mmHg, and heart rate 65 times/minute. Neurological examination revealed that the patient was conscious, the left pupil was 3.4 mm, the right pupil was 3.4 mm, the bilateral eye movements were flexible, no nystagmus or other abnormalities were observed, and the pupillary light reflexes of both eyes were not abnormal. The muscle strength and muscle tone of the limbs were examined, and no abnormalities were found. The patient’s cranial MRI was completed and the results indicated no significant abnormalities. The EEG was completed and showed frequent spike waves in the left central and temporal regions. Therefore, based on the patient’s symptoms and examination results, the diagnosis was benign epilepsy with spike-wave in the central region. Since the disease was benign and the patient had his first seizure, no special treatment was needed, and the family was instructed to closely observe the patient’s physical condition and review it regularly.
Treatment effect
Six months after the patient’s visit, the parents told him that the patient had not had any seizures, was conscious, articulate, and moving well. He was given a physical examination, which showed no significant abnormality, and a repeat brain MRI and EEG, which showed no abnormality. One year after the onset of seizures, the patient was 16 years old and reported that he had had another seizure since the initial onset. The patient’s family was instructed to closely observe and regularly review the patient’s condition. If there are any symptoms such as facial twitching, drooling, with tonicity and convulsions of the limbs and loss of consciousness, the patient should come to the clinic promptly.
IV. Precautions
The patient did not have any more convulsions, and I was very happy about this. However, since the disease is often recurrent, patients and their families should not feel that the crisis is over.
1. Although the patient did not have convulsive symptoms in the future, it is advisable to avoid dangerous activities alone, such as playing roller coasters and jumping machines, as a precautionary measure, and it is also advisable for the patient to take appropriate physical exercise and avoid intense sports. In addition, it is recommended to wrap up the corners of tables at home to avoid injuries when the patient develops, and to avoid sleeping on the top bunk to prevent falling out of bed during the onset.
2. In terms of diet, it is recommended to increase dietary diversity and eat more nutritious foods, such as protein-rich milk and eggs, as well as vitamin-rich fruits and vegetables. However, high sugar and spicy stimulating drinks, such as candy, chocolate, coffee, strong tea, alcohol and chili should be avoided.
V. Personal insight
Benign epilepsy with central temporal spikes is more common in the clinic, manifesting as orofacial convulsions, which can involve one hand and upper limb, and occasionally the lower limb, and some patients may have impaired consciousness. For the treatment of benign epilepsy with central temporal spikes, the patient needs to be selected according to the number of episodes. If it occurs for the first time, close observation is usually the main focus and no medication is given. However, if the patient has recurrent symptoms of benign epilepsy with central temporal spikes, antiepileptic drugs need to be applied. In this case, the patient’s initial onset and subsequent recurrence was never seen, so close observation was chosen. It is reassuring that no convulsive symptoms appeared in further days, which is undoubtedly the best situation for the patient.