Severe psychiatric disorder in an 8-year-old boy with myoclonic-astatic seizures

This chapter inspects the conditions of a boy initially diagnosed with generalized epilepsy with myoclonic-astatic seizures and autism. But later it was found that he had focal frontal lobe epilepsy with severe evolution into a kind of epileptic encephalopathy with bilateral synchrony and myoclonic-astatic seizures. Atypical absences had passed unobserved for a long time-consequently, epilepsy was not considered until he was 6 years old, when brief myoclonic-astatic seizures were recognized. The frequency of the seizures progressively increased until they were occurring more than once a day. The neuropsychological assessment revealed markedly labile attention, deficits in concentration and learning (with no scholastic learning), and language atypias such as lexical impoverishment, a lack of relation to context, and the use of the third person. Treatment with felbamate and valproate before surgery controlled the drop attacks and markedly decreased the other seizures without causing any severe unwanted psychiatric effects. The improvement in epilepsy was actually accompanied by modest behavioral improvement, although the cognitive difficulties persisted. This case shows the interactions between epilepsy and psychiatric, cognitive, and behavioral disturbances. Psychiatric, cognitive, and behavioral disturbances can sometimes prevail over epileptic symptoms to the extent that the diagnosis of epilepsy is missed altogether for a number of years. © 2008 Elsevier Inc. All rights reserved.