Abstracts

Rationale: Reflex epilepsy, an epilepsy syndrome in which seizures are reliably precipitated by specific stimuli, has an estimated incidence of 1 to 6.5% in the epilepsy population. Although rarely seen excepting the Sri Lankan population, eating epilepsy is the most common form of reflex epilepsy, comprising between 30 to 60% of patients in reported case series. Eating epilepsy tends to manifest in the second decade of life, typically in males, and has a suboptimal response to antiepileptic medications. Seizure semiology is varied, but symptomatic, localization-related seizures are most common, frequently associated with a temporal lobe focus on EEG. We report a developmentally normal 18 month old Hmong girl with brief staring episodes followed by perioral cyanosis, shuddering, emesis and post event fatigue, occurring reliably 10 to 20 minutes after oral intake of both solids and liquids. The patient’s history is remarkable for a single febrile seizure occurring 1 month prior to presentation. Methods: This is a case report of a patient who presented to the Children’s Hospital of Wisconsin for evaluation of seizures. Results: Video EEG monitoring demonstrated clinical and electrographic seizure activity occurring 10 minutes after oral intake, characterized by high amplitude rhythmic delta, maximally observed over the right temporal-parietal region with rapid secondary generalization. Clinically, this electrographic activity correlated with a staring spell, confirming the diagnosis of localization-related epilepsy with secondary generalization. MRI demonstrated only nonspecific changes in the peritrigonal white matter. This patient’s seizures ceased after the initiation of low dose Phenobarbital. Repeat video EEG at a 6 month follow-up visit confirmed lack of seizure activity following the activation procedures of eating and drinking; however, occasional interictal sharp wave activity and focal slowing over the left parietal-occipital region were observed. Conclusions: To the best of our knowledge, this patient is both the youngest person with eating epilepsy and the only Hmong patient reported in the literature with this diagnosis. This case demonstrates the utility of video EEG monitoring in the investigation of unusual seizure semiologies. Additionally, the diagnosis of medication responsive eating epilepsy in this young child from a genetically distinct population may help shed light on the etiology of this rare type of epilepsy.