Eye-Closed Sensitivity in a Patient with Idiopathic Generalized Epilepsy

In certain epilepsy syndromes, uncommon electroencephalogram (EEG) patterns linked to oculo-visual responses may yield valuable diagnostic clues. A 16-year-old boy presented with a history of generalized tonic-clonic seizures spanning 4 years. Birth and developmental milestones were normal prior to seizure onset. He denied myoclonic jerks but reported a doubtful history of absences. There was no family history of seizures. He was on carbamazepine with poor seizure control. EEG showed normal background activity with generalized, frontally dominant polyspike and wave discharges at a frequency of 3 Hz. Interestingly, eye closure activated generalized epileptiform discharges, which persisted until eye opening suggesting eye-closed sensitivity (Fig. 1A). Photic stimulation revealed a grade IV photo paroxysmal response at 20 Hz (Fig. 1B). Magnetic resonance imaging was normal. A diagnosis of idiopathic generalized epilepsy (IGE), likely juvenile absence epilepsy (JAE), was made, and he was switched to sodium valproate, resulting in good seizure control.