A 17-year-old female with a history of convulsive syncope developed unprovoked generalized tonic-clonic seizures and achieved complete seizure freedom for 2 years after starting levetiracetam 1,000 mg.
Case Report (n=1)
This case highlights the importance of distinguishing between convulsive syncope and convulsive seizure, which can coexist and transition over time, using detailed seizure semiology and EEG findings.
A 17-year-old woman presented with transient consciousness impairment attack and convulsion after bathing and prolonged standing since age 12. EEG showed WHAM ( wake, high amplitude, anterior, male) type of phantom spikes that usually carry the high risk of epilepsy at age 13. At age 17, EEG wise generalized spike and wave complex was recorded once, and head-up tilt test was positive. She was carefully observed without antiepileptic drugs since convulsive syncope due to neurally mediated syncope was most likely. During the follow-up period, she had eventually unprovoked generalized tonic-clonic seizures (convulsive seizure) twice and thus she was started with antiepileptic drug with success. Although both convulsive syncope and convulsive seizure differ in nature and effects on quality of life, in this patient, the latter occurred later and both occurs together. It is important to distinguish them by means of the degree of convulsion and EEG finding.
Sakakibara-Hayashi et al. (Wed,) conducted a case report in Convulsive syncope and convulsive seizure (n=1). Levetiracetam was evaluated on Seizure freedom. A 17-year-old female with a history of convulsive syncope developed unprovoked generalized tonic-clonic seizures and achieved complete seizure freedom for 2 years after starting levetiracetam 1,000 mg.