Wicket spikes misinterpreted as focal abnormalities in idiopathic generalized epilepsy with prescription of carbamazepine leading to paradoxical aggravation.

Abstract

Wicket spikes (WS) are a normal variant EEG pattern that sometimes can be mistaken for epileptiform activity. We present a patient with WS and idiopathic generalized epilepsy who had been wrongly diagnosed with focal epilepsy, which leads to the prescription of carbamazepine with severe aggravation of generalized tonic-clonic seizures. She was referred for presurgical assessment of refractory focal epilepsy but long-term video-EEG showed sharp theta waves over the temporal regions during awakening, with a typical aspect of WS during drowsiness, nREM sleep stages I-II, and rapid eye movements (REM) sleep. There were a few generalized spike-waves during sleep but interictal changes were increased in frequency at awakening with bursts of fast-generalized spike-waves. Carbamazepine was progressively withdrawn and the patient was progressively switched to zonisamide. The patient no longer complained of generalized tonic-clonic seizures. At one year follow-up, this patient receives zonisamide with valproate. She has remained seizure-free.

• Authors: A Crespel, R Velizarova, P Genton, P Coubes, P Gélisse
• Journal: Neurophysiologie clinique = Clinical neurophysiology (Neurophysiol Clin) Vol. 39 Issue 3 Pg. 139-42 (Aug 2009) ISSN: 1769-7131 [Electronic] France
• PMID: 19716464 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticonvulsants
• Isoxazoles
• Topiramate
• Benzodiazepines
• Clobazam
• Fructose
• Carbamazepine
• Zonisamide
• Clonazepam
• Valproic Acid

Topics

• Anticonvulsants (administration & dosage, adverse effects, therapeutic use)
• Benzodiazepines (administration & dosage, therapeutic use)
• Carbamazepine (administration & dosage, adverse effects, therapeutic use)
• Clobazam
• Clonazepam (administration & dosage, therapeutic use)
• Diagnostic Errors
• Drug Therapy, Combination
• Electroencephalography
• Epilepsy, Temporal Lobe (diagnosis)
• Epilepsy, Tonic-Clonic (chemically induced, diagnosis, drug therapy)
• Female
• Fructose (administration & dosage, analogs & derivatives, therapeutic use)
• Humans
• Isoxazoles (administration & dosage, therapeutic use)
• Middle Aged
• Remission Induction
• Sleep Stages (physiology)
• Temporal Lobe (physiopathology)
• Theta Rhythm
• Topiramate
• Valproic Acid (administration & dosage, therapeutic use)
• Zonisamide