A Case of Frequent Blinking and Abnormal Eyeball Movement Associated with Generalized Epilepsy

Abstract

Eyelid myoclonus is an idiopathic generalized epileptic syndrome that can occur with or without absence seizures. The features include frequent blinking, an upward roll of the eyeballs, and slight backward movement of the head. It can be spontaneous or stimulated by light. Light and eyelid closure are triggers to the seizures. A 13-year-old young male student presented with a four months history of frequent blinking and abnormal eye movements. There was a positive history of leg tapping while asleep which started a year prior to presentation, but there was no loss of consciousness. On presentation, the patient was a young healthy looking myope who frequently blinks with sudden upward and left jerky movements of the eyeballs. Visual acuity was CF at 2 meters in both eyes improving with -4.50DS to 6/6. Intraocular pressures were 12 mmHg bilaterally. Anterior and posterior segment findings were normal. Brain MRI was normal, but EEG was abnormal with features suggestive of generalized epilepsy. He was co-managed with the neurologist and placed initially on Tabs Sodium valproate 250mg for 3 months. This was modified to Tabs Sodium Valproate (controlled release) 500mg at night since there was little change. This resulted in an appreciable reduction in blinking and abnormal eye movement. The leg tapping stopped on this dose. Eyelid myoclonus (EM) is a rare form of epilepsy. It is of utmost importance to create awareness of the disease among physicians. Early diagnosis and treatment are important prognostic factors of the disease. Key Messages: There is a need to create awareness of Eyelid Myoclonus among physicians as this can easily be missed or misdiagnosed.

Keywords: Abnormal Eye Movement; Eyelid Myoclonus; Frequent Blinking; Generalised Epilepsy; Jerky Leg Movement; Sodium Valproate.

Figure 1:

Awake Electroencephalogram (EEG) showed an admix of bilateral and synchronous high voltage brief (< 1 second) poly spike and sharp wave complex with bi-frontotemporal dominance.

Figure 2:

Hyperventilation and photic protocols revealed paroxysms of generalized spike-wave epileptic discharges with a conclusion of generalized epilepsy.

Figure 3:

Repeat EEG done on 10/05/2022 while he was on Sodium Valproate 500mg showed background 15 - 18 Hz beta activity with some 11-14 Hz alpha waves; these are bilaterally synchronous but the response to eye-opening is not ascertained. Left-sided sharp and slow wave discharges, lasting about 1.5 seconds at P3-O1 and C3-P3 channels.