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Título

THE ELECTROENCEPHALOGRAM IN THE RESEARCH OF PROGRESSIVE MYOCLONIC EPILEPSY

RESUMO

Presentation of the Case: A previously healthy 8-year-old patient, with adequate neuropsychomotor development, started a generalized tonic-clonic crisis (TCGC), afebrile, during sleep in October 2021, associated with the presence of sudden movements contraction of limbs, described as "shocks". He underwent a cranial tomography without alterations, remained asymptomatic for two weeks. He evolved with weekly frequency TCG crisis, with sudden movements (myoclonus) daily and started to present behavioral changes. Two months after the onset of the condition, the patient showed gait and speech disturbances and had daily epileptic seizures. Neurological examination: fluctuating alertness, expression aphasia, slow gaze tracking. Myoclonus on the face, incomplete trunk support. Limb coordination: dyskinesia.Balance/gait: gait with a support, discreetly dyskinetic and on tiptoe.
Exams: CSF: clear;0 leukocytes;2 red blood cells; proteins 26; Cranial MRI:multifocal signal alteration affecting the subcortical white matter of both cerebral hemispheres, without cytotoxic edema or intramyelinic edema. EEG: abnormal, due to diffuse disorganization of sleep activity, with asymmetry, worse in the left hemisphere. Generalized, polyphasic, high-amplitude periodic activity at 3- to 6-second intervals. After the EEG result, the hypothesis of subacute sclerosing panencephalitis due to measles (characteristic clinical picture, typical EEG) was made, and a new CSF puncture showed negative immunology for measles IgM and IgG 1:32 and protein electropheresis with the presence of multiple bands in the gamma region (81.3%).
Discussion: Subacute sclerosing panencephalitis (SSPE) is a progressive and fatal neurodegenerative encephalitis caused by the persistence of measles virus in the central nervous system (CNS). In the state of Ceará, there were 916 confirmed cases of measles between December 2013 and September 2015. The only concrete strategy against measles and its complications is prevention through vaccination. The COVID-19 pandemic has left a dangerous immunity gap due to the suspension of measles awareness campaigns and delay in immunization, leading to medical concern about the risk of further measles outbreaks in the coming years.
Final comments: In this case, we highlight the electroencephalogram as a fundamental exam for the diagnosis, showing the periodic complexes with a long interval, thus directing the investigation in the CSF to confirm the pathology.

Palavras Chave

ELECTROENCEPHALOGRAM; MYOCLONIC EPILEPSY; SUBACUTE SCLEROSING PANENCEPHALITIS

Área

Epilepsia