Background: Currently, only a small number of reports address the variations in the electroencephalogram (EEG) of patients with orthostatic dysregulation (OD). We present a case of OD demonstrating diffuse high voltage EEG slow wave bursts triggered by the orthostatic challenge (OC).
Case Report: An 8-year-old boy was diagnosed with epilepsy and administered valproate (VPA) from the age of 8 years and 1 month, considering the symptoms of loss of consciousness and generalized convulsion. After 6 months, he only lost consciousness when he walked around the room while in school. We performed video EEG monitoring to detect psychogenic non-epileptic seizures (PNES), during which no apparent seizures were observed; furthermore, he had neither background abnormalities nor paroxysms when both awake and asleep. Additionally, we administered OC, and his heart-rate increased to >50 bpm from the baseline along with symptoms of nausea and inability to remain standing. His EEG presented diffuse high voltage slow wave bursts. We diagnosed him as having PNES with OD.
Discussion: Several reports confirm the decrease in the rate of background activities of EEG in OC or head-up tilt test (HUT). Here, we recognized a slow wave of EEG and tachycardia induced by brain hypoperfusion, suggesting that EEG with OC can provide useful information for OD from a pathophysiological perspective.
Conclusions: Diffuse high voltage EEG slow wave burst with OC may ensure accurate diagnosis of OD.