Hemiconvulsion-hemiplegia-epilepsy syndrome: clinical course and neuroradiological features in a 20-month-old girl

BMJ Case Rep. 2014 Mar 10:2014:bcr2013203482. doi: 10.1136/bcr-2013-203482.

Abstract

Hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome involves initial sudden and prolonged unilateral convulsive seizures, followed by transient or permanent hemiplegia and epilepsy during infancy or early childhood. Seizures are prolonged, difficult to control and sometimes may require surgery. Hemiplegia varies in intensity, differs from Todd paralysis and disappears in about 20% of cases. Neuroimaging characteristically shows brain atrophy more pronounced on the hemisphere contralateral to the side of hemiplegia with dilation of the ventricular system. A 20-month-old girl presented with left hemiconvulsions and left hemiplegia lasting for a prolonged period. Seizures failed to resolve with various anticonvulsants even after many physician contacts. Characteristic neuroimaging findings, seizure control with carbamazepine and valproate, subsequent recovery of hemiplegia and attainment of developmental milestones observed on follow-up confirmed HHE syndrome. The case highlights the need for good seizure control in this syndrome.

Publication types

  • Case Reports

MeSH terms

  • Anticonvulsants / therapeutic use
  • Atrophy
  • Brain / diagnostic imaging*
  • Brain / pathology
  • Carbamazepine / therapeutic use
  • Epilepsy / diagnostic imaging*
  • Epilepsy / drug therapy
  • Female
  • Hemiplegia / diagnostic imaging*
  • Hemiplegia / drug therapy
  • Humans
  • Infant
  • Syndrome
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Valproic Acid / therapeutic use

Substances

  • Anticonvulsants
  • Carbamazepine
  • Valproic Acid