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A case of infantile spasms: epileptic apnea as partial seizures at onset
1Department of Pediatrics, School of Medicine, Iwate Medical University, Japan.
Insights
This study details a rare case of infantile spasms evolving from epileptic apnea in a 2-month-old boy. Early apnea seizures progressed to infantile spasms, highlighting a unique developmental pathway in pediatric epilepsy.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Infantile spasms (IS) are a severe epilepsy syndrome in infants.
- Apneic attacks can be an atypical presentation of seizures in neonates and infants.
Observation:
- A 2-month-old boy presented with apneic attacks as the sole manifestation of epileptic seizures.
- Ictal electroencephalogram revealed focal temporal paroxysmal discharges.
- The patient progressed to infantile spasms by 6 months of age.
Findings:
- Epileptic apnea, a rare seizure manifestation, preceded the development of infantile spasms in this case.
- Sodium valproate was ineffective, but zonisamide, vitamin B6, or high-dose immunoglobulin controlled the spasms.
- Despite seizure control, severe neurodevelopmental retardation was observed.
Implications:
- This case represents the first reported instance of infantile spasms evolving from epileptic apnea as partial seizures.
- Highlights the importance of recognizing atypical seizure presentations in infants.
- Suggests a distinct pathophysiological pathway for certain cases of infantile spasms.
Abstract:
We report a 2-month-old boy who presented with apneic attacks as a manifestation of epileptic seizures at onset and eventually progressed to infantile spasms. At onset, at 2 months of age, apneic attacks were the sole symptom of epileptic fits. Although these seizures were accompanied by cyanosis, bradycardia was not noted. An ictal electroencephalogram showed focal paroxysmal discharges in the temporal area. Treatment with sodium valproate was not effective to control his seizures. By 6 months of age, he progressed to infantile spasms. Although his seizures could be completely controlled with the use of zonisamide, vitamin B6 or high-dose immunoglobulin, his mental and behavioral development was retarded severely. There have been no previously published cases with infantile spasms that evolved from epileptic apnea as partial seizures.