Elmi Humen, Kilinçaslan Ayşe, Oztürk Mücahit, Yapici Zuhal
Department of Child and Adolescent Psychiatry, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
Turk J Pediatr. 2011 Sep-Oct;53(5):574-8.
We report a case emphasizing the association of epilepsy with psychopathology. The patient was first referred for impulsive and inattentive behavior at the age of 4, and was diagnosed with attention deficit hyperactive disorder. At the age of 7, intermittent daytime episodes characterized with sudden fear and purposeless running, jumping, clapping, and rocking started. Electroencephalography (EEG) recordings did not reveal any abnormality. Two years later, night-time episodes started, which were quite similar to the daytime spells. An overnight EEG showed bilateral frontal spike and wave discharges predominating on the right. Magnetic resonance imaging revealed gliotic changes in the anterior frontal areas, and neuropsychologic assessment findings were compatible with frontal lobe damage. Treatment with carbamazepine not only controlled hyperkinetic motor seizures but also helped interictal inattentiveness and behavioral impulsivity. In our case, ictal behavioral changes were masked by interictal behavioral disturbances and the normal findings in some of EEG records delayed the diagnosis.
我们报告了一例强调癫痫与精神病理学关联的病例。该患者4岁时首次因冲动和注意力不集中行为被转诊，被诊断为注意力缺陷多动障碍。7岁时，开始出现间歇性日间发作，其特征为突然恐惧以及无目的的奔跑、跳跃、拍手和摇晃。脑电图（EEG）记录未显示任何异常。两年后，夜间发作开始，与日间发作颇为相似。一次夜间脑电图显示双侧额叶棘波和慢波放电，右侧更为明显。磁共振成像显示额叶前部区域有胶质增生变化，神经心理学评估结果与额叶损伤相符。卡马西平治疗不仅控制了运动性多动癫痫发作，还改善了发作间期的注意力不集中和行为冲动。在我们的病例中，发作期行为改变被发作间期行为障碍所掩盖，且部分脑电图记录的正常结果延误了诊断。
