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An unusual presentation of a common disorder
  1. Gillian Halla,
  2. Brian Mc Namarab,
  3. Julian Rayb,
  4. Simon Bonifaceb
  1. aAddenbrookes Hospital, Cambridge, UK: Department of Neurology, bDepartment of Clinical Neurophysiology
  1. Dr Brian Mc Namara, Department of Clinical Neurophysiology Box 124, Addenbrookes Hospital, Cambridge CB2 2QQ, UK (e-mail: b.mcnamara{at}

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A 59 year old right handed man presented with a one week history of twitching of the right hand side of his face. This would spread to involve his right arm and hand. There was no background medical history of note and he was on no medication. On examination the right hand side of his face was continually twitching. Neurological examination did not reveal any further abnormalities. The results of investigations are shown in box 1.

Box 1: Investigations

  • Computed tomography of the brain: normal

  • Electroencephalography: focal slow wave activity over the left parietal region

  • Urea 17.9 mmol/l

  • Sodium 131 mmol/l

  • Creatinine 97 mmol/l

  • Potassium 4.7 mmol/l

  • Serum osmolarity 313 mOsmol/l

  • Glucose 31.4 mmol/l


What is this uncommon epilepsy syndrome called?
What is the connection between the abnormal biochemistry and the neurological presentation?
In what proportion of cases of this syndrome will computed tomography or magnetic resonance imaging of the brain be abnormal?

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