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Visual agnosia in a child with non-lesional occipito-temporal CSWS
Kai Eriksson1, Anneli Kylliäinen, Kari Hirvonen
1Tampere University Hospital, Pediatric Neurology Unit and Medical School, University of Tampere, Tampere, Finland. kai.eriksson@uta.fi
Insights
This study details a child with continuous spike-wave discharges during sleep (CSWS) and severe visual agnosia. Findings highlight the link between CSWS and visual recognition deficits in children.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Clinical Electrophysiology
Background:
- Visual agnosia in children is often linked to symptomatic occipito-temporal conditions.
- Published reports associate visual agnosia with specific neurological and developmental symptoms.
Observation:
- A case study of an 8-year-old boy with sporadic seizures and occipito-temporal continuous spike-wave discharges during slow sleep (CSWS).
- The child exhibited severe visual agnosia despite normal visual acuity, neurological examination, and MRI.
- Extensive electrophysiological monitoring revealed over 85% non-REM sleep affected by continuous spike-and-wave activity.
Findings:
- Neuropsychological testing showed normal verbal intelligence but significant deficits in visual perception, object recognition, shape discrimination, and copying.
- Attention, executive functions, and memory were intact.
- Verbal cues and tactile tracing demonstrated potential compensatory strategies for visual deficits.
Implications:
- This case expands the understanding of the neuropsychological spectrum associated with CSWS in children.
- Highlights the importance of sleep EEG in diagnosing children with unexplained visual and neuropsychological issues.
- Emphasizes the need for comprehensive neuropsychological assessments for diagnosis and targeted rehabilitation in pediatric CSWS cases.
Abstract:
In this paper we describe a case of severe visual agnosia in a child with an electrophysiological pattern of continuous spike-wave discharges in slow sleep (CSWS) in the occipito-temporal regions. The neuropsychological spectrum related to this phenomenon is discussed. Published paediatric reports associate visual agnosia (i.e. an inability to recognize objects without impairment of visual acuity) mainly with symptomatic occipito-temporal aetiology (e.g. cortical dysplasia, vascular insults) and other neurological symptoms (e.g. autism). We describe a detailed 2 year electrophysiological and neuropsychological follow-up of an 8-year-old boy with sporadic seizures, occipito-temporal CSWS and visual agnosia. The growth and neurological development of the child had been considered as normal, neurological examination did not reveal any focal signs, visual acuity was intact and MRI was normal. First EEG and six consecutive 24 h video EEG recordings during the follow-up of 22 months showed continuous spike-and-wave activity covering over 85% of the non-REM sleep. According to structured neuropsychological tests (Wechsler Intelligence Scale for Children--Third Edition, A Developmental Neuropsychological Assessment (NEPSY), Test of Visual-Perceptual Skills, Corsi block, Hooper Visual Organization Test) the boy had normal verbal intelligence but major deficits in visual perception, especially in object recognition, impaired shape discrimination and detection, and poor copying skills. Attention and executive functions were intact. There were no difficulties in short- or long-term memory. Verbal cues and naming the objects improved visual memory. Tracing the objects with a finger or by moving the head improved object recognition. Currently the boy attends a special school with a rehabilitation plan including neuropsychological and occupational therapies. This case adds a new facet to the spectrum of neuropsychological deficits in children with CSWS. Sleep EEG should be included in the etiological studies of children with specific neuropsychological problems and detailed neuropsychological assessment is needed for diagnostic and rehabilitation purposes.