Juvenile Myoclonic Epilepsy

Abstract

A 21-year-old right-handed white female with well-controlled epilepsy developed normally without medical conditions or risk factors. Seizure onset was noted at 17 years of age after a night of “cramming” for a final examination in history class. After the test she stayed out with friends until 1 am. She admitted to drinking four Red Bull^® energy drinks and staying out late with friends before returning home to sleep. The following day she experienced headache and nausea. When she went to brush her teeth, her right arm jerked, and her toothbrush was jettisoned from her hand. She went to eat breakfast but continued to be “shaky” and found it difficult to eat her cereal due to jerky motions that created trouble guiding the spoon to her mouth. She then described the occurrence of similar jerking in the morning in the first half hour of awakening over the last 2 years. As she was telling her parents about the night before, she suddenly turned her head to the left, let out a scream, and fell to the ground. She was unconsciousness and manifested generalized tonic stiffness and clonic jerking bilaterally for 1 min. She was then tired, sleepy, and confused. Her parents called 911, and she was taken to the ED. In the ED, she was disoriented and confused but without focal or lateralizing features to her neurological examination. A CT brain was normal. An EKG and laboratory testing included a normal CBC, liver function studies, and electrolyte panel, and creatinine was normal. She was given intravenous levetiracetam and was admitted to the hospital overnight. An MRI of the brain was normal and an EEG had the following results (see Fig. 7.1).