Patient 2 is a female who is currently 5 years 9 months old. She exhibited a delay in achieving some developmental milestones, such as head lifting at 4 months, independent sitting at 1 year and independent walking at 2 years. She could say “baba,” or “mama” at the age of 1 year but exhibited regression in development with subsequent instances of only unconscious articulation. Nevertheless, she possessed non-verbal communication skills. Hand clapping was observed at 8 months. She displayed good eye contact as well as a purposeful hand use. She presented recurrent, febrile or non-febrile, generalized tonic-clonic seizures at 10 months; after being treated with LEV at the age of 15 months, she achieved a seizure-free status. Her seizure, which was characterized as a generalized tonic seizure without fever, relapsed at the age of 3 years and was treated with valproate (VPA) and LEV. She achieved a seizure-free status when she was 3.5 years old. EEG (15 months) findings revealed spike-and-slow waves with bilateral temporal and occipital involvement. MRI findings at the age of 10 months were normal ().
Patient 3 is a female who is currently 4 years 4 months old. She showed some signs of developmental delay, such as lifting her head at the age of 5 months, sitting independently at the age of 9 months, and walking at the age of 2 years; she also did not exhibit any non-verbal communication skills and could not imitate actions or babble. Poor eye contact was observed at the age of 8 months. Hand clapping and hand wringing were observed when she was 1 year 6 months old. She demonstrated purposeful hand use, and at the age of 8 months, she experienced recurrent, febrile or non-febrile, generalized tonic-clonic seizures. She presented with status epilepticus, which later became absence status epilepticus at the age of 3 years 2 months. At this time, she was started on LEV medication but showed no response to it; subsequently, VPA was added to the treatment strategy at the age of 3 years 6 months, and the patient finally achieved a seizure-free status at the age of 4 years. Her EEG tests at the age of 15 months demonstrated sharp-slow synthetical waves at the left central and left parietal-frontal regions. EEG showed generalized sharp-slow waves and MRI findings indicated delayed myelination in the periventricular area at the age of 3 years 2 months ().