Singultus as main seizure type in a patient with primary generalized epilepsy

Persistent singultus is a rare condition occasionally caused by central nervous system abnormalities. We report on a six year-old girl with daily hiccup events since three months. A video-polygraphic recording capturing 9 singultus episodes showed myoclonias of the diaphragm lasting 100–150ms time-locked to generalized 2.5–3/s spike-slow wave discharges in the EEG. Jerk-locked averaging revealed a positive-negative-positive EEG transient with central maximum preceding the onset of the EMG discharge by 82.9ms. This is the first description of a patient with epilepsy and hiccup as the main seizure type. The electrophysiological findings suggest a primary generalized form of epilepsy and a polysynaptic impulse transmission.