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Recurrent attacks of fear and visual hallucinations in a child
Hans-Jürgen Huppertz1, Peter Franck, Rudolf Korinthenberg
1Department of Neuropediatrics, Epilepsy Center, University of Freiburg, Germany. huppertz@nz.ukl.uni-freiburg.de
Insights
A child
Area of Science:
- Pediatric Neurology
- Neuroscience
Background:
- Recurrent panic-like attacks in children can be challenging to diagnose.
- Differential diagnoses include anxiety disorders, parasomnias, and nightmares.
Observation:
- A 7-year-old boy experienced severe nocturnal and daytime episodes with fear and visual hallucinations.
- Routine EEG and MRI were normal; psychotherapy for adjustment disorder was ineffective.
Findings:
- Long-term video-electroencephalography (video-EEG) revealed left temporal seizure patterns.
- Focal epilepsy originating from the left anteromedial temporal lobe, possibly involving the amygdala, was diagnosed.
- High-resolution MRI showed cortical dysplasia in the suspected seizure focus.
Implications:
- This case highlights the diagnostic challenges in differentiating epilepsy from other episodic disorders.
- Long-term video-EEG is crucial for accurate diagnosis and effective treatment of complex episodic events in children.
- Early and accurate diagnosis of focal epilepsy can prevent prolonged ineffective treatments.
Abstract:
The case of a 7-year-old boy suffering from recurrent nocturnal and occasional daytime attacks with intense fear and complex visual hallucinations is presented. His state was otherwise normal, as were routine electroencephalographic (EEG) and magnetic resonance imaging (MRI) investigations in the past. Several differential diagnoses such as panic disorder, pavor nocturnus, and nightmares were considered but could not be definitely established or excluded. Since the attacks appeared after the divorce of his parents, an adjustment disorder was suspected, and the patient received psychotherapy for more than 2 years without an effect on the attacks. Only when long-term video-EEG recorded two typical attacks with left temporal ictal seizure patterns was focal epilepsy diagnosed and successfully treated with antiepileptic medication. A suspected origin of seizures in the amygdala was supported by a high-resolution MRI showing a cortical dysplasia extending from the left anteromedial temporal lobe to the amygdala. The case exemplifies difficulties in the differential diagnosis of panic-like attacks and underlines the value of long-term video-EEG, which may be necessary to establish the correct diagnosis and to prevent ineffective therapeutical approaches.