Paroxysmal pain as sole manifestation of seizures

A developmentally normal 4-year-old white female who presented with pain in the right hand as the only manifestation of epilepsy is reported. Two years later, she developed complex partial seizures following right-hand pain. Computed tomography and magnetic resonance imaging were unremarkable. Prolonged ambulatory electroencephalography (EEG) as well as video-EEGs with ictal pain episodes failed to reveal abnormalities. Only a full night video-EEG performed after antiepileptic drug withdrawal demonstrated 2 right-hand pain episodes followed by a complex partial seizure with ictal epileptiform activity on the scalp EEG in the left parasagittal area, rapidly generalized and interictal discharges in the C3-P3 area. This patient had a very unusual presentation of epilepsy.