Lennox-Gastaut Syndrome and Behavioral Disorder: A Case Report of Unrecognized Epilepsy in Infancy

In several African settings, the diagnosis of epilepsy in infancy is still delayed, and uncommon epileptic presentations, especially when associated with behavioral disorder, can pass unrecognized and remain untreated for several years. We present the case of a 2-year-and 7-month-old male child being referred to the Developmental Intervention Clinic for a behavioral disorder and suspected seizures. The anamnesis revealed a past history consistent with infantile spasms from the age of 6 months. Subsequently, the child presented with daily episodes of staring gaze, sudden flexion of the head and trunk associated with abduction, and elevation of the upper limbs. Sporadic episodes of confusional state associated with drowsiness were also reported. At the time of evaluation, the patient presented with a speech delay and behavioral disorder characterized by severe hyperactivity and pica. The child never received antiepileptic treatment. Electroencephalography revealed an electrical pattern consistent with Lennox-Gastaut syndrome. Treatment with sodium valproate was started with initial significant seizure reduction, resolution of pica, and some improvement in his communication and behavior.