A 73-year-old woman presented with a history of recurrent self-limited stupor episodes. Metabolic, vascular, structural, epileptic, toxicologic (exogenous), and sleep disorders were excluded after the pertinent investigations. We present video-EEG results during one of the episodes (video 1).
Video 1
Video EEG. During one of the clinical episodes, diffuse 14-Hz background activity can be seen while the patient presented with drowsiness, poorly reactive to stimuli. After administration of 0.2 mg flumazenil, a benzodiazepine antagonist, there is a change in alpha activity, accompanied clinically by a transient improvement in consciousness.Download Supplementary Video 1 via http://dx.doi.org/10.1212/011548_Video_1
Idiopathic recurring stupor is an uncommon and controversial condition, with diagnosis requiring exclusion of a variety of other causes of stupor and supported by the detection of elevated levels of endozepine-4 in serum and CSF during episodes.1,2 In the right clinical context, characteristic EEG pre and post administration of flumazenil and clinical response to this drug can be suggestive.
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