Cerebrotendinous Xanthomatosis: Novel EEG finding of Fixation-Off Sensitivity

Cerebrotendinous Xanthomatosis (CTX) is a rare autosomal recessive condition resulting in accumulation of cholesterol and cholestanol due to disrupted bile synthesis. Affected tissues include brain, tendons, skin, bone, lungs, and eyes. We report a clinical case presenting with epilepsy, which has b...

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Main Authors: Zachary Mills, James Thomas Houston, Ashley Thomas, Kelsey Shoenmeyer
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:Epilepsy & Behavior Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2589986425000309
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author Zachary Mills
James Thomas Houston
Ashley Thomas
Kelsey Shoenmeyer
author_facet Zachary Mills
James Thomas Houston
Ashley Thomas
Kelsey Shoenmeyer
author_sort Zachary Mills
collection DOAJ
description Cerebrotendinous Xanthomatosis (CTX) is a rare autosomal recessive condition resulting in accumulation of cholesterol and cholestanol due to disrupted bile synthesis. Affected tissues include brain, tendons, skin, bone, lungs, and eyes. We report a clinical case presenting with epilepsy, which has been described, however with a particular EEG appearance that appears novel with Fixation-Off Sensitivity (FOS). The patient’s EEG showed significant buildup of abnormal slowing and frontally predominant generalized epileptiform discharges when her eyes were closed, and in contrast essentially normal tracings while eyes were open, eventually showing electrographic evolution and generating a bilateral tonic-clonic seizure. Genetic testing confirmed the diagnosis of CTX, and CTX-specific treatment with chonodeoxycholic acid was initiated in addition to anti-seizure medication.
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series Epilepsy & Behavior Reports
spelling doaj-art-1d3c8af5cfdc42aeaebb5cb07c95ed7a2025-08-20T03:12:57ZengElsevierEpilepsy & Behavior Reports2589-98642025-06-013010077010.1016/j.ebr.2025.100770Cerebrotendinous Xanthomatosis: Novel EEG finding of Fixation-Off SensitivityZachary Mills0James Thomas Houston1Ashley Thomas2Kelsey Shoenmeyer3UAB Epilepsy Center, Department of Neurology, 1719 6th Avenue South, CIRC 312, 35294 Birmingham, AL, United States of AmericaCorresponding author.; UAB Epilepsy Center, Department of Neurology, 1719 6th Avenue South, CIRC 312, 35294 Birmingham, AL, United States of AmericaUAB Epilepsy Center, Department of Neurology, 1719 6th Avenue South, CIRC 312, 35294 Birmingham, AL, United States of AmericaUAB Epilepsy Center, Department of Neurology, 1719 6th Avenue South, CIRC 312, 35294 Birmingham, AL, United States of AmericaCerebrotendinous Xanthomatosis (CTX) is a rare autosomal recessive condition resulting in accumulation of cholesterol and cholestanol due to disrupted bile synthesis. Affected tissues include brain, tendons, skin, bone, lungs, and eyes. We report a clinical case presenting with epilepsy, which has been described, however with a particular EEG appearance that appears novel with Fixation-Off Sensitivity (FOS). The patient’s EEG showed significant buildup of abnormal slowing and frontally predominant generalized epileptiform discharges when her eyes were closed, and in contrast essentially normal tracings while eyes were open, eventually showing electrographic evolution and generating a bilateral tonic-clonic seizure. Genetic testing confirmed the diagnosis of CTX, and CTX-specific treatment with chonodeoxycholic acid was initiated in addition to anti-seizure medication.http://www.sciencedirect.com/science/article/pii/S2589986425000309Cerebrotendinous Xanthomatosis (CTX)Fixation-Off Sensitivity (FOS)EpilepsyElectroencephalography (EEG)CYP27A1 Gene
spellingShingle Zachary Mills
James Thomas Houston
Ashley Thomas
Kelsey Shoenmeyer
Cerebrotendinous Xanthomatosis: Novel EEG finding of Fixation-Off Sensitivity
Epilepsy & Behavior Reports
Cerebrotendinous Xanthomatosis (CTX)
Fixation-Off Sensitivity (FOS)
Epilepsy
Electroencephalography (EEG)
CYP27A1 Gene
title Cerebrotendinous Xanthomatosis: Novel EEG finding of Fixation-Off Sensitivity
title_full Cerebrotendinous Xanthomatosis: Novel EEG finding of Fixation-Off Sensitivity
title_fullStr Cerebrotendinous Xanthomatosis: Novel EEG finding of Fixation-Off Sensitivity
title_full_unstemmed Cerebrotendinous Xanthomatosis: Novel EEG finding of Fixation-Off Sensitivity
title_short Cerebrotendinous Xanthomatosis: Novel EEG finding of Fixation-Off Sensitivity
title_sort cerebrotendinous xanthomatosis novel eeg finding of fixation off sensitivity
topic Cerebrotendinous Xanthomatosis (CTX)
Fixation-Off Sensitivity (FOS)
Epilepsy
Electroencephalography (EEG)
CYP27A1 Gene
url http://www.sciencedirect.com/science/article/pii/S2589986425000309
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AT ashleythomas cerebrotendinousxanthomatosisnoveleegfindingoffixationoffsensitivity
AT kelseyshoenmeyer cerebrotendinousxanthomatosisnoveleegfindingoffixationoffsensitivity