Neuropediatrics 2010; 41(6): 261-263
DOI: 10.1055/s-0031-1271657
Short Communications

© Georg Thieme Verlag KG Stuttgart · New York

Recurrent Upper Motor Neuron Facial Weakness of Possible Epileptic Etiology: A Case Report

H. Hartmann1 , T. Lücke1 , 2
  • 1Department of Paediatrics, Hannover Medical School, Germany
  • 2Department of Neuropaediatrics, Children's Hospital, University of Bochum, Germany
Further Information

Publication History

received 15.06.2010

accepted 04.01.2011

Publication Date:
28 March 2011 (online)

Abstract

We report on an otherwise healthy infant who presented with clusters of alternating central facial nerve paresis. At 11 months of age, the patient showed intermittent facial asymmetry compatible with right-sided upper motor neuron facial paresis and accompanying incomplete upper motor neuron hypoglossal paresis. Laboratory work-up and imaging studies did not reveal signs of infection, infarction or structural lesions, and after one week, symptoms spontaneously resolved. Similar episodes affecting alternate sides were noted at ages of 17, 27 and 49 months lasting for 4–14 days. At 49 months, EEG showed right temporo-occipital benign sharp waves with activation during drowsiness and sleep. A diagnosis of benign focal epilepsy with negative motor phenomena was made. She is now 60 months old and no further episodes have occurred without antiepileptic treatment. Ictal orofacial phenomena are the clinical hallmark of benign focal epilepsy with centro-temporal sharp waves (BECTS). As in our patient, negative epileptic motor phenomena frequently lead to a broad diagnostic work-up. In infants presenting with episodic central facial nerve paresis, the possibility of negative epileptic motor phenomena should be considered.

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Correspondence

Hans HartmannMD 

Department of Paediatrics

Medizinische Hochschule

Hannover

Carl-Neuberg-Strasse 1

30625 Hannover

Germany

Phone: +49/511/532 3247

Fax: +49/511/532 3222

Email: hartmann.hans@mh-hannover.de