A 4-year-old boy with benign partial epilepsy and hyperkinetic behavior between seizures is reported from Sapporo Medical University, Japan. Hyperactivity was noted at age 3, and seizures began at 4 years 6 months. Attacks consisted of a terrified expression, crouching, and rubbing his forehead on the floor. They occurred in sleep and awake. An ictal EEG in sleep showed theta rhythm, predominant over the left hemisphere, followed by voltage depression, but no spike and wave complexes. Both seizures and hyperkinetic behavior responded to carbamazepine. The epilepsy was characterized as benign partial epilepsy with affective symptoms. [1]

COMMENT. Behavioral and emotional disorder as a form of epilepsy is a controversial topic, and the response to antiepileptic drugs in treatment is not proof of epilepsy. This patient tends to support the concept of a specific epileptic syndrome, BPEAS, but the EEG evidence could be more convincing.

The following study provides evidence against the concept of a so-called “masked epilepsy” in some hyperkinetic children. A comparison of the emotional and behavioral problems of 53 children, aged 6-12 years, with epileptiform EEG discharges and those of children without this EEG abnormality showed no significant differences, in a study at the Tokyo Medical and Dental University; the Nihon University; Asai Hospital, Chiba; and National Center for Neurology and Psychiatry, Kodaira, Japan. The authors conclude that the emotional and behavioral problems are coincidental and not directly related to the epileptiform discharges. [2]