Electrical status epilepticus during sleep: a case report and review of the literature.

We present the case of a 5-year-old male who other than being six weeks premature at birth had no significant early medical problems, and had normal physical and cognitive development until preschool. It was then that his teacher noticed the child was having learning difficulties, staring spells, and difficulty expressing himself He had a single generalized tonic-clonic seizure (GTCS) in September of 2008. A routine EEG revealed very frequent epileptiform discharges. He was started on levetiracetam and four months later his EEG showed continuous spike wave discharges during sleep. The spike wave discharges occurred in long runs, lasting a minute or more, without clear ictal evolution. The spike wave discharges were seen in a generalized distribution, maximal bifronto-temporally with some asymmetry (right greater than left). When the patient was subsequently awakened, the EEG dramatically improved and the spike wave discharges almost completely resolved. The spike and wave discharges recurred as the patient became drowsy again. Authors have described this as electrographic status during sleep (ESES) which is a typical childhood process of generalization of paroxysmal activity and can be seen with specific childhood epileptic encephalopathies. Treatment with levetiracetam was increased and his EEG and language subsequently returned to normal.