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An 18-year-old female college student is evaluated in the emergency department because of a seizure that occurred that morning. According to her roommate, the patient woke up at her usual time and had several episodes of brief bilateral arm jerks before she fell and lost consciousness. Her whole body stiffened for 5 to 10 seconds, and then she had rhythmic clonic jerking of her arms, legs, and trunk for about 2 to 3 minutes. She remained unresponsive for 10 minutes and then gradually regained complete consciousness over the next hour. The patient remembers the arm jerks but has no recollection of the seizure. She states that she has been having arm jerks in the morning for several months, which have become worse recently. She has been staying up late every night for the last week studying for final examinations. Neurologic examination is normal.
Which of the following is the most likely diagnosis?
A Partial seizure with secondary generalization
B Absence epilepsy
C Syncope
D Juvenile myoclonic epilepsy
E Pseudoseizure
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YEAH AGREE...bt i may hav second thot abt dd..coz sleep deprivation characteristically causes myoclonic seizures n given the pt past history abt arm jerks..which is indicative of myoclonic seizures with rememberance ..charact of myoclonic seizures..
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nope..A is not the correct answer
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ohh sorry I have seen just ur first two words of reply
Answer and Critique (Correct Answer = D)
Key Point
Juvenile myoclonic epilepsy is a primary, genetic, generalized epilepsy that typically manifests with myoclonic jerks followed by a generalized tonic“clonic seizure.
The patient had myoclonic jerks that led to a generalized tonic“clonic seizure. This is a typical presentation of juvenile myoclonic epilepsy, an idiopathic epilepsy syndrome. Affected patients have a normal neurologic examination and normal development. Unlike other idiopathic epilepsies, remission is rare even after years without seizure, so lifelong treatment is necessary. Patients are sensitive to sleep deprivation, alcohol, and stress. It is often necessary to specifically ask the patient whether there have been any other episodes of jerks involving the head, extremities, or trunk. Patients may have been experiencing these for some time but not have associated the myoclonus with seizures.
Unlike juvenile myoclonic epilepsy, which is a primary, genetic, generalized epilepsy, partial seizures originate from a focal part of the brain and their clinical presentation depends on their neuroanatomic location. A partial epilepsy may present with a simple partial seizure (consciousness not impaired) or complex partial seizure (consciousness impaired) before progressing to a generalized tonic“clonic seizure, although some patients with partial epilepsies present with generalized tonic“clonic seizures only. The patient with partial epilepsy may show a focal abnormality on electroencephalography or on MRI. Idiopathic generalized epilepsies present with only generalized onset seizures, which may be convulsive or nonconvulsive. Absence seizures are nonconvulsive generalized onset seizures that mainly affect children. Absence seizures manifest with sudden onset of staring, with or without eye blinking or lip smacking.
The other options are unlikely. Patients with syncope often have several myoclonic jerks while unconscious, but they recover quickly once blood pressure is re-established. Nonepileptic events (pseudoseizures) vary in presentation but are often associated with moaning, crying, and arrhythmic shaking of the body.
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i was of the opinion that there is no LOC in myoclonic seizure...thats y i went with A....
i accept dat its Juv myoclonic epilepsy, can u plz explain on wat basis did we rule out A?
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hey successor,I think expln is pretty clear..seizure in stressful situation and characteristic arm jerk..ans also questn..most likely diagnosis??
