ABSTRACT
Case Presentation ................................................................................................... 239 Differential Diagnosis ............................................................................................240 Diagnostic Approach .............................................................................................240 Treatment Strategy .................................................................................................240 Long-Term Outcome ..............................................................................................242 Pathophysiology/Neurobiology of Disease ............................................................242 Clinical Pearls ........................................................................................................ 243 Suggested Reading ................................................................................................. 243
The patient is a 15-year-old boy who was seen at an emergency department in the early morning hours after he was witnessed to have a seizure at a party. He was at summer camp and had stayed up longer-and slept less-than usual for most of the preceding days. His friends recalled that he yelled, stiffened, and then jerked with his whole body for about 1 minute. He had bloody frothing at the mouth and lost bladder control. Afterwards, the staff at the camp was unable to arouse him for another 15 minutes, and he later woke up slightly disoriented, complaining of sore muscles “all over.” The patient did not recall any warning signs prior the incident, and was amnestic for the episode. This was the rst event of this kind, and he and his parents denied any prior history of seizures or staring spells during infancy and childhood. However, when asked specically, he admitted to noticing muscle twitches in his shoulders and arms for the past 6 months. They typically occurred in the morning, after getting up, and had, at times, interfered with his daily routine before leaving for school. He recalls once involuntarily throwing a toothbrush across the bathroom, and another time when a jerk made him drop his cereal bowl on the oor. His examination was completely normal.
