Continuous spike-waves of slow-wave sleep: A case study with 20-year follow-up

Abstract

Objective . To understand the pathogenesis of continuous spike-waves of slow-wave sleep in autistic spectrum disorders, and how to precisely manage such a challenging complex chronic case. This is the case of PM, a 5 year old right-handed girl from Gujrat India who first presented with dizziness and vomiting while sleeping. Onset of such events started one and a half year ago. She also cried in between and lost consciousness for about 10 minutes’ duration. She suffered a partial seizure and her parents started AED therapy-one year and a half later. She first presented when she was five years and 3 months of age in India. PM is currently a 20-year-old right-handed woman who was followed for 16 years by the same neurologist (PAH), had seizure onset at 1.5 years: afebrile seizures secondarily generalized with automatisms, duration about 5 minutes, recurrent every 2–5 weeks. Initial treatment consisted of Phenytoin 12 mg/kg, then Carbamazepine 30 mg/kg+ (starting dose), Valproate at 18 mg/kg/day with improvement. SGA 2.7 kg at birth, after 7–8 hours labour, her “right leg was bent” at birth in India. Family history was negative for fits or epilepsy. Her early development was “normal”: walked at 12 months, spoke words in Gujarati at 18 months, started English as a second language (ESL) at four years old in Junior kindergarten when she first came to Canada with her family. Since then she had completed high school at age 20 years and planned post-secondary studies at college to be determined by her parents. Her EEGs showed almost continuous high amplitude spike-waves 60% or more in SWS, but only mildly abnormal when awake. Her last clinical seizure occurred a few years ago, still in high school, off all AEDs. The general neurological examination was unremarkable but was rather delayed. Discussion . The relationship between sleep and epilepsy is a challenging issue. In this case the correlation between sleep and possible ASD is unequivocally important. Poor quality in sleep for the pediatric age group often leads to future cognitive and psychosocial issues. These issues must be addressed precisely and handled with parent and psychosocial intervention. An increased level of education and awareness of her condition may help improve the long-term prognosis and improve the quality of life of the patient.