Case 17 - Look below the Surface (EEG)

Summary

This 57-year old man was brought to the emergency department with a six-month history of episodic jaw pulling and arm flexion and subsequent progressive cognitive decline over this period. Initially rare, the episodes became more frequent. At the time of the hospital admission, he had one nearly every 20–30 minutes. Episodes were brief (three to five seconds) and most often unilateral but could affect either side. He was transiently disoriented with each episode, increasingly even up to a minute after motor signs’ termination. Phenytoin, valproate, and clonazepam used during the six-month period prior to admission did not provide any benefit. Initially, he was unimpaired between episodes, but about three months prior to his admission, he was noted to exhibit uncharacteristic slowed thinking and disorganization. He manifested difficulties recalling recent events and repeating stories or questions. He became depressed, withdrawn, and easily irritated. At his initial examination in the hospital, he was observed to have multiple stereotypical episodes (Video 17.1).