Featured Case - Spring 2020

Contributed by Meghana Raghavan MD, Sara Frey MD, Zubeda Sheikh MD, Department of Neurology, West Virginia University School of Medicine

Clinical Presentation

35-year-old woman with a history of mild intellectual disability and epilepsy onset at age 7 was seen in neurology clinic for initial evaluation. She had prolonged episodes of decreased responsiveness when she would be “in a fog” lasting 1-2 days, and at other times would have multiple daily eye rolling episodes as a child. She was started on valproic acid after an EEG showed generalized epileptiform abnormalities. At age 17, she had two convulsions on attempted medication taper. She presented to us at age 35 with a pre-existing diagnosis of Jeavon’s syndrome. Family reported no spells in past several years on continued valproic acid use. An ambulatory EEG was obtained to evaluate for unrecognized seizures and assess interictal burden.

Fig 1 (Bipolar Montage)

Fig 1 (Referential Montage)

Fig 2 (Bipolar Montage)

Fig 2 (Referential Montage)

Question 1: What phenomenon do the above EEG clips depict?

  1. Photoparoxysmal response
  2. Photomyoclonic response
  3. Eye Closure Sensitivity
  4. Fixation-off Sensitivity
Answer: (click here)

Question 2: What clinical conditions are the above EEG findings associated with?

  1. Idiopathic Childhood Occipital Epilepsies
  2. Idiopathic Generalized Epilepsy
  3. Asymptomatic children without epilepsy
  4. All the above
Answer: (click here)



  1. Brigo F, Rossini F, Stefani A, et al. Fixation-off sensitivity. Clin Neurophysiol 2013;124:221-7.
  2. Panayiotopoulos CP. Fixation-off, scotosensitive, and other visual-related epilepsies. Adv Neurol 1998;75:139-57.
  3. Ogura K, Maegaki Y, Koeda T. EEG evaluation of fixation-off sensitivity in eyelid myoclonia with absences. Pediatr Neurol 2005;33:142-5.
  4. Maher J, Ronen GM, Ogunyemi AO, Goulden KJ. Occipital paroxysmal discharges suppressed by eye opening: variability in clinical and seizure manifestations in childhood. Epilepsia 1995;36:52-7.
  5. Koutroumanidis M, Tsatsou K, Sanders S, et al. Fixation-off sensitivity in epilepsies other than the idiopathic epilepsies of childhood with occipital paroxysms: a 12-year clinical-video EEG study. Epileptic Disord 2009;11:20-36
  6. Agathonikou A, Koutroumanidis M, Panayiotopoulos CP. Fixation-off-sensitive epilepsy with absences and absence status: video-EEG documentation. Neurology 1997;48:231-4.


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