Acquired visual agnosia as an uncommon presentation of epileptic encephalopathy in a 6-year-old boy with CSWS.
Epilepsy Behav Rep 2021;
16:100465. [PMID:
34258574 PMCID:
PMC8253950 DOI:
10.1016/j.ebr.2021.100465]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Acquired visual agnosia is an underrecognized and rare manifestation of CSWS.
Highly specific spared and affected areas of visual performance may be seen.
Methylprednisolone was found most effective to treat cognitive symptoms.
Recovery on EEG (SWI) and neuropsychological results showed partial synchronicity.
SWI is likely not the only neurophysiological marker of epileptic encephalopathy.
Background
Acquired visual agnosia in the context of continuous spikes and waves during slow sleep (CSWS) is rarely described. We present a case of an almost 7-year-old boy who lost his ability to name pictures and recognize familiar faces. Initial encephalography (EEG) revealed sleep induced epileptiform activity with a spike-wave index (SWI) of 100%, predominanting in the left posterior head region.
Methods
Serial neuropsychological testing with concomitant EEG was done during the first 18 months of treatment with intravenous methylprednisolone. We administered intelligence scales, verbal tasks (memory, fluency), visual tasks (drawings, search, face recognition), and tasks requiring visual-verbal integration (picture naming, visual closure).
Analyses
Neuropsychological recovery studied with reliable cognitive change cut-offs and 95% confidence intervals.
Results
With treatment, there was an improvement of the EEG pattern (SWI reduction to 45%), followed by a relapse (SWI 82%). Neuropsychological measures in part synchronized with improvement, stability, and fluctuating values. Significant increases were seen on Verbal Comprehension Index and semantic memory. Visual Spatial Index remained unchanged (67 to 73). Naming pictures showed only limited change. Interpreting degraded pictures remained extremely difficult.
Discussion
Acquired visual agnosia may be seen in children with CSWS. Early recognition, prompt accurate treatment and tailored neuropsychological assessment remain crucial.
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