EPILEPTIC NYSTAGMUS IN INFANCY

Epileptic nystagmus (EN) is a rare form of nystagmus that occurs only during epileptic seizures. We report an infantile case in which EN was first noted at 10 days of age. Electronystagmography showed a right-b eating nystagmus with predominantly linear slow phases that traversed the midline. Neuro-imaging revealed dysplasia of the left middle tempo ral gyrus extending posteriorly into the parieto-occipital cortex. The right hemisphere and subcortical structures appeared normal. Perfusio n studies demonstrated interictal hypoperfusion with ictal hyperperfus ion in the left temporal lobe. Electrocorticography demonstrated spiki ng over the left temporal-parieto-occipital region. Following extensiv e surgical resection of this area and weaning of anti-convulsants, the child has remained seizure-free without nystagmus. This case demonstr ates the cortical origin of EN, and shows that infant cortex has funct ioning efferent connections to brainstem oculomotor centres from 10 da ys of age. (C) 1997 Elsevier Science B.V.