. however , focal abnormalities on electroencephalography ( eeg ) have also been observed in patients with generalized epilepsy . in such cases
, it is supposed that the cortical focus drives widespread epileptic networks that results in generalized seizures .
, we describe a patient who had eyelid myoclonia with absences , along with focal motor seizures .
ictal video - eeg recording showed generalized spike  waves preceded by focal frontal discharges , suggesting that focal cortical abnormalities may induce eyelid myoclonia with absences .
the patient is a 7-year - old boy who exhibited eyelid myoclonia with absence seizures .
since the age of 5  years , he complained of involuntary movements of the eyelids , which occurred a few times per week . a physician diagnosed this as a tic disorder .
however , his parents and brother noticed brief episodes of unresponsiveness , often associated with jerks of the eyelids , lasting 35  s. these episodes gradually increased in frequency , occurring many times a day .
eyelid movement appeared like rapid blinking and was often accompanied with upward deviation of the eyeballs and retropulsion of the head .
1 ) . further , eeg recording during the interictal period showed normal background activity and focal epileptiform discharges over the frontal regions ( fig .
however , he experienced a focal motor seizure with impairment of consciousness and a generalized tonic seizure during sleep in the next 2  years .
the focal seizures consisted of clonic movements of the right upper limb and upward deviation of the eyeballs , lasting less than a minute . the onset of the generalized seizure was not detected .
when the patient started to have focal seizures , he underwent mri scanning of the brain , the result of which showed no abnormality .
we describe the case of a patient with eyelid myoclonia with absences who had been misdiagnosed with facial tic disorder .
our patient had eyelid myoclonia that appeared like rapid blinking and was often associated with jerky upward deviation of the eyeballs and retropulsion of the head .
the absences were brief , lasting 35  s. ictal eeg revealed 4- to 5-hz generalized polyspike  waves .
these electroclinical features were in contrast to those of a typical absence seizure in childhood absence epilepsy wherein the eyes look straight ahead , and the absence seizures are associated with 3-hz spike - and - wave discharges over a longer duration .
eyelid myoclonia has been well recognized as the clinical feature of seizures in individuals with generalized epilepsy .
jeavons syndrome , a form of generalized epilepsy , is clinically characterized by the triad of eyelid myoclonia with or without absences , eye closure - induced seizures or eeg paroxysms , and photosensitivity .
electroencephalographic manifestations have been described as focal frontal or occipital predominant epileptiform discharges followed by generalized epileptiform discharges in both interictal and ictal recordings .
thus , it has been suggested that either the frontal or the occipital lobe initiates eyelid myoclonia .
a recent cortical stimulation study has demonstrated that vertical upward eye movements can be induced by electrical stimulation of the frontal eye field ( fef ) , which is located in the frontal cortex .
upward deviation of the eyeballs occured with frontal epileptiform activity in a patient with epilepsy .
a subgroup of children with absence epilepsy showed an eeg epileptic abnormality with frontal onset of the typical generalized 3-hz spike - and - wave discharges .
dense - array eeg , a technique that improves the spatial resolution of scalp eeg , has demonstrated that selective cortical networks in the frontal lobe are involved in the propagation of ictal discharges in absence seizures .
further , microarchitectural abnormalities in the frontal lobe have also been reported as potential facilitators of seizures in juvenile myoclonic epilepsy , another generalized epilepsy . in generalized epilepsy
, many brain regions have a tendency to reach an epileptogenicity level that exceeds the seizure threshold .
thus , generalized seizures may start from focal brain regions and tend to generalize very fast .
eyelid myoclonia with absences may represent a type of secondarily generalized seizure originating in the frontal lobe . in conclusion
, our case suggests an important role of the frontal lobe in the generation of eyelid myoclonia with absences .
eyelid myoclonia with absences is a unique type of absence seizure associated with a variety of epilepsy syndromes .
our case supports the concept that there is no absolute distinction between generalized and focal epilepsy but rather a continuum .
 eyelid myoclonia with absences is classified as a unique type of generalized seizure . 
 its pathogenesis is proposed to involve the functional abnormalities in cortical  subcortical networks . here 
 , we describe the case of a 7-year - old boy who had eyelid myoclonia with absences , along with focal motor seizures . 
 video - eeg monitoring demonstrated eyelid myoclonia associated with 4- to 5-hz generalized polyspike  
 waves preceded by focal frontal discharges . 
 interictal eeg showed focal epileptiform discharges over the frontal regions . 
 our case suggests an important role of the frontal lobe in the generation of eyelid myoclonia with absences . 
Introduction
Case report
Discussion
Conflict of interest