Severe hypoglycemic seizures in a child receiving 6-mercaptopurine.

A 4-year-old boy with acute lymphoblastic leukemia who was receiving 6-mercaptopurine during the maintenance chemotherapy experienced prolonged generalized tonic nocturnal seizures because of severe hypoglycemia after his evening dose by a 12-hour period of fasting. Investigations ruled out all causes of these seizures other than the 6-mercaptopurine-induced severe hypoglycemia.

Severe cerebral vaso-occlusive disease in macrophage activation syndrome.

A 14-year-old girl was diagnosed with macrophage activation syndrome, based on clinical presentation, laboratory tests, and bone marrow aspirate findings. She developed severe central nervous system involvement in the form of seizure disorder and severe diffuse occlusive cerebral vasculopathy, with extensive collateral circulation consistent with moyamoya disease. To our knowledge, this description is the first of these findings in association with macrophage activation syndrome.

Morvan syndrome following B-cell lymphoma.

Morvan syndrome is a rare autoimmune disease named after the French physician Augustin Marie Morvan. It is characterized by multiple, irregular contractions of the long muscles, weakness, pruritus, hyperhidrosis, insomnia, and delirium. Here, we describe a 17-year-old young man, previously diagnosed with B-cell lymphoma, who presented with multiple asynchronous fasciculations of the long muscles of his lower extremities accompanied by numbness. The patient responded initially to pulse corticosteroids with diminution of the fasciculations. He achieved complete remission following 7 consecutive, monthly intravenous immunoglobulin injections. The present case is described in the context of the available literature.

Common causes of uncommon seizures.

Afebrile seizures associated with rotavirus gastroenteritis, respiratory syncytial virus bronchiolitis, influenza infection, asthma, blood transfusions, and intake of a number of drugs (including theophylline, cephalosporins, metronidazole, and acyclovir) with therapeutic drug levels are uncommonly encountered in clinical practice. Reviewed here are the incidence, etiology, clinical presentation, types, diagnosis, associated electroencephalographic changes, and cranial magnetic resonance imaging findings in the literature, as well as management and prognosis of these seizures.

A child with refractory complex partial seizures, right temporal ganglioglioma, contralateral continuous electrical status epilepticus, and a secondary Landau-Kleffner autistic syndrome.

A 7-year-old, right-handed girl started to have seizures at age 1 year 4 months. She developed normally until age 4 when she had worsening of seizures with auditory verbal agnosia, complete aphasia, and a behavioral disorder fulfilling the diagnostic criteria of autism. Medical therapy failed. MRI revealed a right temporal tumor. Video/EEG monitoring at age 7 showed contralateral electrical status epilepticus in wakefulness and sleep and ipsilateral onset of seizures. Resection (ganglioglioma with excessive inflammation) resulted in seizure freedom and marked reduction of the autistic features. This case is unique for being, to our knowledge, (1) the first in which a lesion located in the right, rather than left, temporal lobe resulted in secondary falsely localizing left temporal lobe electrical status epilepticus with a clinical picture of Landau-Kleffner syndrome and autism, and (2) the fourth reported patient with lesional Landau-Kleffner syndrome to respond to resective surgery.