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Transient psychosis in a girl with epilepsy and continuous spikes and waves during slow sleep (CSWS)
M Kyllerman1, A Nydén, N Praquin
1Department of Pediatrics, East Hospital, University of Göteborg, Sweden.
Insights
A rare epilepsy syndrome caused continuous spikes and waves during slow sleep, leading to cognitive decline and psychosis in a child. Despite initial improvement, severe mental impairment persisted after a second psychotic episode.
Area of Science:
- Pediatric Neurology
- Neuropsychiatry
- Epileptology
Background:
- Epilepsy in childhood can present with diverse neurological and psychiatric manifestations.
- Disintegrative psychosis is a rare condition characterized by a profound loss of previously acquired skills.
Observation:
- A 6-year-old girl developed epilepsy with generalized tonic-clonic seizures and atypical absences.
- Electroencephalogram (EEG) revealed progressive epileptiform activity, including bilateral synchronous spike-wave discharges.
- Sleep EEG demonstrated continuous spikes and waves during slow sleep, a key diagnostic feature.
Findings:
- The patient experienced significant deterioration in cognitive and behavioral functions.
- A full-blown disintegrative psychosis developed, lasting several months.
- Despite initial neuropsychiatric improvement, a subsequent psychotic episode resulted in severe mental impairment by age 9.
Implications:
- This case highlights the potential for severe neuropsychiatric sequelae in certain pediatric epilepsy syndromes.
- Continuous spikes and waves during slow sleep may indicate a poor prognosis for cognitive and behavioral outcomes.
- Further research is needed to understand the underlying mechanisms and develop targeted treatments for such complex cases.
Abstract:
A normally developed and healthy 6-year-old girl suffered the onset of epilepsy with generalized tonic-clonic seizures and atypical absences. Initially the EEG showed epileptiform activity over the temporal and parietal regions, later there were episodes of bilateral synchronous spike-wave activity with a frequency of 1.5-2.5 Hz. After a few months, deterioration of cognitive and behavioural functions appeared and gradually increased with the development of a full-blown disintegrative psychosis that went on for several months. Sleep EEG recordings showed the characteristic abnormality described as continuous spikes and waves during slow sleep. Later there was a remarkable improvement of neuropsychiatric functions but a second outbreak of psychosis seems to have left the girl, who is now 9 years of age, with severe mental impairment.