Anoxic–epileptic seizures: New case reports

Abstract

Objective: Anoxic-epileptic seizures (AES) are underreported events mainly happening in infancy when true epileptic seizure is triggered by syncope. Methods: 3 case studies of AES (one presented as life-threatening event) and follow-up were analyzed and compared to previously published data. Results: Case 1: Normally developed girl had had typical prolonged expiratory apnea (PEA) since 6 m. First AES happened at 1y2m, epileptic component presented as 20 min clonic seizure. Two days later similar episode repeated. Interictal EEG was normal. She received VPA for 1 year, two episodes of PEA repeated, no epileptic component followed. Since 2,5y till 6y no epileptic or non-epileptic event had happened. Case 2: The boy aged 1 y was referred for evaluation of the episodes of choking during feeding followed by apnea with prominent cyanosis and afterwards clonic seizures of arms and face muscles developed into status epilepticus. He had delayed development, dysmorphic features, karyotype 46,ХY,del(4)(15.1). Bronchoscopy showed anatomic defect of larynx. VPA had been prescribed. No AES repeated during 1 year. Case 3: 11 m old normally developed girl admitted to the emergency room due to the state of unresponsiveness with eyes and head deviation to the left, slight clonic seizures of face muscles and hands lasting for 40 minutes. Parents described classic presentation of reflex anoxic syncope followed by unresponsiveness and clonic seizures. Ambulance staff did not recognize AES and decided to perform CT because of minor trauma. Later the girl was brought to our hospital, status epilepticus was stopped only at ICU with thiopental. First clinical signs of brain edema appeared, but full recovery followed. She is not on AED. During 1,5 year only one PEA happened. Conclusion: Presented case reports correspond to previously published data on AES. Medical community has to be aware of AES especially because its common complication is status epilepticus. Generally, AES have favorable prognosis.