Late onset of tonic seizures with negative routine EEG and neuroimaging and positive SPECT and sleep EEG

This case report deals with a female patient who started having generalized tonic seizures on sleep onset at the age of 28. More events followed with scattered frequency identical to the first one. Brain CT scan and MRI as well as routine EEGs have always been negative across several years. Recently with a SPECT, PAO eco-tomography a reduced blood flow involving a huge area of the left hemisphere was detected, while on the sleep EEG focal theta activity appeared interictally during the second part of the night corresponding to the right parietal leads.