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[Case report of muscle cramp versus focal epilepsy]
H Fujita1, H Muranaka, S Osari
1Department of Pediatrics, Hirosaki University School of Medicine, Aomori.
Abstract:
We report here a boy suffering from muscle cramps in the right upper extremity. At 32 days of age, he developed purulent meningitis followed by paresis of the right upper extremity. From infancy he had intermittent episodes myoclonus-like involving the right hand. Since he also had true epileptic seizures with loss of consciousness, ocular deviation, and vomiting at 6 and 8 years of age, he was treated with anti-epileptic drugs as therapy for focal motor seizures. At 6 years of age, these episodes increased in frequency. The cramps spread from the right hand to involve the entire upper extremity with pain. At the age of 10, he was referred to Hirosaki University Hospital and was admitted. Using closed circuit television with continuous EEG and EMG monitoring we observed during his episodes repeated EMG abnormalities consisting of continuous discharges of polyphasic motor unit potentials, but no epileptic EEG discharges. We diagnosed these episodes as muscle cramp. His muscle cramps were controlled by medication with muscle relaxants and Chinese medicines. This case illustrates that the differential diagnosis between muscle cramps and epileptic seizures is important for proper treatment.
Insights
This case study highlights a child with muscle cramps misdiagnosed as epilepsy. Proper diagnosis using electroencephalogram (EEG) and electromyography (EMG) is crucial for effective treatment.
Area of Science:
- Neurology
- Clinical Medicine
Background:
- A pediatric case presenting with recurrent episodes resembling focal motor seizures.
- History of purulent meningitis and paresis in the right upper extremity since infancy.
Observation:
- Intermittent myoclonus-like episodes in the right hand since infancy.
- Epileptic seizures with loss of consciousness, ocular deviation, and vomiting at ages 6 and 8.
- Increased frequency of episodes at age 6, spreading to the entire upper extremity with pain.
- Continuous EEG and EMG monitoring revealed EMG abnormalities (polyphasic motor unit potentials) without epileptic EEG discharges during episodes.
Findings:
- Diagnosis of muscle cramps confirmed through continuous EEG and EMG monitoring.
- Distinction between muscle cramps and epileptic seizures was established.
Implications:
- Emphasizes the importance of differential diagnosis between muscle cramps and epileptic seizures in pediatric neurology.
- Highlights the role of advanced monitoring techniques (EEG/EMG) in accurate diagnosis.
- Successful management of muscle cramps achieved with muscle relaxants and traditional Chinese medicines.