The Turkish Journal of Pediatrics
2011 , Vol 53 , Num 5
A Case with Hyperkinetic Frontal Lobe Epilepsy Presenting as a Psychiatric Disturbance
1 Department of Child and Adolescent Psychiatry, and 3Division of Child Neurology, Department of Pediatrics, İstanbul
University İstanbul Faculty of Medicine, and 2Department of Child and Adolescent Psychiatry, Yeditepe University Faculty
of Medicine, İstanbul, Turkey
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.
Keywords :
frontal lobe epilepsy, attention deficit hyperactivity disorder, frontal lobe
damage.