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P02.10 Periodic lateralized epileptiform discharges: Differential diagnosis
Posters / Clinical Neurophysiology 117 (2006) S121–S336
the presence of nonlinear dynamics. Bursts of epileptiform discharges during a non-convulsive SE are manifestations of multiple, recurring, unstable, nonlinear brain states. doi:10.1016/j.clinph.2006.06.196
P02.10 Periodic lateralized epileptiform discharges: Differential diagnosis N. Gonza`lez Arnau 1, M. Ferrandiz 1, L. Martin 1, A. Molins 2, L. Ramio´ 2 1 2
Josep Trueta Hospital, Clinical Neurophysiology, Spain Josep Trueta Hospital, Neurology, Spain
Background: Periodic lateralized discharges (PLEDs) are associated with acuted processes and with structural lesions. Seizures can occur with PLEDs. Objectives: Evaluation and follow-up of a patient with an olfactory aura and a secondary generalized seizure. Electroencephalogram (EEG) showed PLEDs. Methods: We described a 43 years old man, who developed partial seizures with olfactory aura and secondary generalization, in the course of a feverish process. No other pathologic antecedent was known.Different studies were practised: magnetic resonance imaging (MRI) of the brain, blood and spinal fluid tests, and sequenced EEGs. Results: First EEG revealed PLEDs over right frontotemporal lobes with normal background rhythms and sleep spindle rhythms over two hemispheres. Subsequent EEG records showed focal disturbances : delta and theta activity (structural lesion) over right fronto-temporal lobes, but no epileptiform abnormalities; background rhythms and sleep spindles have been always normal. MRI of brain showed a lot of focal cortico-subcortical lesions over right hemisphere. Later MRI studies revealed progression to necrosis of known structural lesions over right fronto-temporal lobes. First diagnosis was of encephalitis probably by herpes virus. Treatment with Acyclovir* was initiated. Fifteen days later, patient described headache, motor left seizures and bradipsychi. Exploration revealed left hemiparesis and left hemihypoesthesis. Computed tomography (CT) demonstrated a large right fronto-temporal lesion. Biopsy diagnosis were Multiform Glyoblastoma. Conclusion: Importance of sequenced EEG recording to support focal acuted structural lesion. PLEDs with normal background in wakefulness and sleep, initially and during follow-up, reject a diffuse encephalitic process and confirm a structural lesion. doi:10.1016/j.clinph.2006.06.197
P02.11 Bilateral on-line EEG and EcoG during peri-insular hemispherotomy: Methodology and demonstration of dependent secondary epileptogenesis (mirror focus)
S129
D. Debatisse, E. Pralong, R. Daniels, R. Roulet, J.G. Villemure CHUV, NCH-UNN, Switzerland Background: The presence of epileptic spikes from the normal hemisphere is often encountered in patient’s candidates for the surgical treatment of hemispheric epilepsy. This would seem at first a contraindication to surgery; however, the possibility of secondary epileptogenesis is to be taken into account when contemplating surgery in these circumstances. Such epileptic abnormalities could be dependent or independent from the primary foci located in the hemisphere to be operated. In the case of dependent foci, surgery could cure the epilepsy; on the other hand, persistent seizures could result if the foci were independent before surgery, though the seizure burden might be substantially reduced with surgery. Methods: We present the methodology of bilateral intra operative monitoring using scalp EEG (EEG) and electrocorticography (EcoG), and the results obtained during peri-insular hemispherotomy in a child with pharmaco resistant epilepsy who preoperatively presented bilateral electrographic epileptic abnormalities. Results: Bilateral on-line EEG and EcoG monitoring during peri-insular hemispherotomy is feasible. It confirmed the per-operative disappearance of the epileptic abnormalities present in the non-operated hemisphere. It confirmed the effect of hemispheric disconnection on contralateral dependent or independent spikes, and their immediate cessation. Conclusion: To our knowledge, this methodology is for the first time applied, in human hemispheric epilepsy, to monitor secondary epileptogenesis with an online demonstration of the extinction of the contralateral foci. doi:10.1016/j.clinph.2006.06.198
P02.12 Cyclic complex partial seizures every 35 days: A case report E. Araus 1, A. Gomez 1, V. Ortiz 2, I. Guijarro 1, P. Garcia 1, I. Arroyo 1, A. Mercado 1 1 2
General Yagu¨e hospital, Clinical Neurophysiology, Spain General Yagu¨e Hospital, Psychology, Spain
Introduction and objectives: Seizures are often related to circadian rhythms like changes in hormone secretion, sleep and awakefulness and environmental factors. These factors are specific for each epileptic syndrome and its cerebral topography. The role of infradian rhythms, however, is much less known. We present a case of cyclic epilepsy that occurs every 35 (34–36) days for 4 years without evidence of any identifiable trigger factor.
the presence of nonlinear dynamics. Bursts of epileptiform discharges during a non-convulsive SE are manifestations of multiple, recurring, unstable, nonlinear brain states. doi:10.1016/j.clinph.2006.06.196
P02.10 Periodic lateralized epileptiform discharges: Differential diagnosis N. Gonza`lez Arnau 1, M. Ferrandiz 1, L. Martin 1, A. Molins 2, L. Ramio´ 2 1 2
Josep Trueta Hospital, Clinical Neurophysiology, Spain Josep Trueta Hospital, Neurology, Spain
Background: Periodic lateralized discharges (PLEDs) are associated with acuted processes and with structural lesions. Seizures can occur with PLEDs. Objectives: Evaluation and follow-up of a patient with an olfactory aura and a secondary generalized seizure. Electroencephalogram (EEG) showed PLEDs. Methods: We described a 43 years old man, who developed partial seizures with olfactory aura and secondary generalization, in the course of a feverish process. No other pathologic antecedent was known.Different studies were practised: magnetic resonance imaging (MRI) of the brain, blood and spinal fluid tests, and sequenced EEGs. Results: First EEG revealed PLEDs over right frontotemporal lobes with normal background rhythms and sleep spindle rhythms over two hemispheres. Subsequent EEG records showed focal disturbances : delta and theta activity (structural lesion) over right fronto-temporal lobes, but no epileptiform abnormalities; background rhythms and sleep spindles have been always normal. MRI of brain showed a lot of focal cortico-subcortical lesions over right hemisphere. Later MRI studies revealed progression to necrosis of known structural lesions over right fronto-temporal lobes. First diagnosis was of encephalitis probably by herpes virus. Treatment with Acyclovir* was initiated. Fifteen days later, patient described headache, motor left seizures and bradipsychi. Exploration revealed left hemiparesis and left hemihypoesthesis. Computed tomography (CT) demonstrated a large right fronto-temporal lesion. Biopsy diagnosis were Multiform Glyoblastoma. Conclusion: Importance of sequenced EEG recording to support focal acuted structural lesion. PLEDs with normal background in wakefulness and sleep, initially and during follow-up, reject a diffuse encephalitic process and confirm a structural lesion. doi:10.1016/j.clinph.2006.06.197
P02.11 Bilateral on-line EEG and EcoG during peri-insular hemispherotomy: Methodology and demonstration of dependent secondary epileptogenesis (mirror focus)
S129
D. Debatisse, E. Pralong, R. Daniels, R. Roulet, J.G. Villemure CHUV, NCH-UNN, Switzerland Background: The presence of epileptic spikes from the normal hemisphere is often encountered in patient’s candidates for the surgical treatment of hemispheric epilepsy. This would seem at first a contraindication to surgery; however, the possibility of secondary epileptogenesis is to be taken into account when contemplating surgery in these circumstances. Such epileptic abnormalities could be dependent or independent from the primary foci located in the hemisphere to be operated. In the case of dependent foci, surgery could cure the epilepsy; on the other hand, persistent seizures could result if the foci were independent before surgery, though the seizure burden might be substantially reduced with surgery. Methods: We present the methodology of bilateral intra operative monitoring using scalp EEG (EEG) and electrocorticography (EcoG), and the results obtained during peri-insular hemispherotomy in a child with pharmaco resistant epilepsy who preoperatively presented bilateral electrographic epileptic abnormalities. Results: Bilateral on-line EEG and EcoG monitoring during peri-insular hemispherotomy is feasible. It confirmed the per-operative disappearance of the epileptic abnormalities present in the non-operated hemisphere. It confirmed the effect of hemispheric disconnection on contralateral dependent or independent spikes, and their immediate cessation. Conclusion: To our knowledge, this methodology is for the first time applied, in human hemispheric epilepsy, to monitor secondary epileptogenesis with an online demonstration of the extinction of the contralateral foci. doi:10.1016/j.clinph.2006.06.198
P02.12 Cyclic complex partial seizures every 35 days: A case report E. Araus 1, A. Gomez 1, V. Ortiz 2, I. Guijarro 1, P. Garcia 1, I. Arroyo 1, A. Mercado 1 1 2
General Yagu¨e hospital, Clinical Neurophysiology, Spain General Yagu¨e Hospital, Psychology, Spain
Introduction and objectives: Seizures are often related to circadian rhythms like changes in hormone secretion, sleep and awakefulness and environmental factors. These factors are specific for each epileptic syndrome and its cerebral topography. The role of infradian rhythms, however, is much less known. We present a case of cyclic epilepsy that occurs every 35 (34–36) days for 4 years without evidence of any identifiable trigger factor.