A Case of Epilepsy with Grand mal on Awakening Complicated by Orthostatic Dysregulation

Abstract：This report presents the case of a １４ year old girl who presented with epilepsy asso-ciated with grand mal on awakening combined with orthostatic dysregulation（OD）. She com-plained of a loss of consciousness and fell down after getting up. She was evaluated by repeated electroencephalography examinations including overnight recordings, but no paroxysmal dis-charges were apparent. Her passive head up tilt test was positive. The initial diagnosis was OD and she was treated with dihydroergotamine and given general advice about habit modification. However, the seizures continued after the initiation of treatment. These symp-toms improved with the administration of valproic acid, and therefore the patient was finally di-agnosed to have epilepsy with grand mal on awakening and OD. As many as ２６％ of all patients demonstrating epilepsy with grand mal on awakening do not show any electroencephalographic abnormalities. Though OD remains an important differential diagnosis for epilepsy, it some-times also occurs in combination with epilepsy.Key words：Epilepsy with grand mal on awakening, Orthostatic dysregulation, Syncope, Head up tilt test