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Recurrent upper motor neuron facial weakness of possible epileptic etiology: a case report

H Hartmann1, T Lücke

  • 1Department of Paediatrics, Hannover Medical School, Hannover, Germany. hartmann.hans@mh-hannover.de

Neuropediatrics
|March 30, 2011
PubMed

Insights

Episodic facial and hypoglossal nerve weakness in infants may signal benign focal epilepsy. Early diagnosis of this rare condition, characterized by negative epileptic motor phenomena, is crucial for appropriate management.

Area of Science:

  • Pediatric Neurology
  • Epileptology
  • Neurophysiology

Background:

  • Benign focal epilepsy with centro-temporal sharp waves (BECTS) is a common childhood epilepsy syndrome.
  • Ictal orofacial phenomena are characteristic but can be challenging to diagnose, especially in infants.
  • Negative epileptic motor phenomena, such as facial nerve paresis, can mimic other neurological conditions.

Observation:

  • An infant presented with recurrent, alternating episodes of central facial nerve paresis and hypoglossal nerve paresis.
  • Symptoms resolved spontaneously, and initial investigations ruled out infection, infarction, or structural lesions.
  • Electroencephalogram (EEG) revealed benign sharp waves in the right temporo-occipital region during sleep.

Findings:

  • The patient was diagnosed with benign focal epilepsy presenting with negative motor phenomena.
  • Antiepileptic treatment led to the cessation of further episodes.
  • The case highlights the atypical presentation of BECTS in infants.

Implications:

  • Episodic facial nerve paresis in infants warrants consideration of epileptic etiologies, specifically BECTS.
  • Recognizing negative epileptic motor phenomena can prevent extensive and unnecessary diagnostic work-ups.
  • This case underscores the importance of EEG in diagnosing subtle epileptic manifestations in pediatric neurology.

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