A 7-year-old female child presented in the Pediatric Neurology clinic of
our hospital with history of three episodes of tetanic carpopedal spasms
in past one month. The first episode occurred when she was studying and
suddenly felt numbness and tingling of both lower extremities followed
by of upper extremities. She then developed spasm of both wrists and
posturing suggestive of carpopedal spasm. She was taken to the nearest
Emergency room where she was given injection calcium gluconate after
which she improved and was discharged on oral calcium. Serum calcium was
not done because of non-availability of the same at this facility. Two
days later, she again had similar posturing of both hands. She was taken
to another hospital where she improved within a few minutes. After 12
hour of this admission, she started complaining of pain in abdomen, both
hands and both feet along with fisting (posture as carpopedal spasms) of
both hands. The posturing improved within 20-30 minutes of the
admission. Serum calcium, Random blood sugar, Serum sodium, Potassium
and electrocardiogram at the time of admission were within normal
limits. Her arterial blood gas analysis was also within normal ranges.
After this event, she was evaluated in the Pediatric Neurology clinic,
and a review history revealed that prior to the start of every event she
always had a strange feeling in her lower extremity described as
discomfort or numbness. This feeling was followed by a typical posturing
of her both hands. Moreover, she continued to feel the strange feeling
in her both lower extremities, especially distal leg and feet, for
around 10-30 minutes. This history prompted us to keep seizure
originating from the somatosensory area and then progressing to motor
area as one of the possibilities. EEG revealed presence of focal
interictal epileptiform discharges in the form of 50-200 microvolt
spike–slow wave complexes originating from left temporal area. MRI brain
revealed mild loss of volume and thinning of grey matter involving left
hippocampal formation with prominence of adjacent temporal horn;
however, no significant T2/FLAIR hyperintense signals are noted from
either of the hippocampus suggestive of mesial temporal sclerosis.
Focal seizures presenting as tetany is a very rare
manifestation of temporal lobe epilepsy. Tetany may indicate enhanced
neuromuscular activity and associated sensory disturbance [1].
Somatosensory aura occurs very rarely as a part of temporal lobe seizure
semiology. Tonic and dystonic posturing in temporal lobe epilepsy may
also be a part of automatisms [2]. In the current patient, the dystonic
posturing of hands mimicked tetany and therefore prompted the treating
clinician to think of commoner etiologies of tetany.
The case is reported to increase awareness amongst
the pediatricians regarding carpopedal spasm as one of the rare
manifestation of temporal lobe epilepsy.
