Periodic Lateralized Epileptiform Discharges After Complex Partial Status Epilepticus Associated With Increased Focal Cerebral Blood Flow

Department of Neurology, Medical College of Ohio, Toledo 43617, USA.
Journal of Clinical Neurophysiology (Impact Factor: 1.43). 12/2001; 18(6):565-9. DOI: 10.1097/00004691-200111000-00007
Source: PubMed


Periodic lateralized epileptiform discharges (PLEDs) are typically associated with encephalitis, cerebral abscess, cerebral infarct, and status epilepticus. There is considerable debate as to whether this pattern is ictal or interictal when seen in association with status epilepticus. We present a patient with complex partial status epilepticus who developed PLEDs and remained comatose despite optimal drug therapy. Technetium 99m single-photon emission computed tomography (SPECT) showed hyperperfusion that resolved with further aggressive antiepileptic drug therapy, indicating that this pattern may indeed be ictal. Further studies are needed to define the significance of PLEDs in patients with status epilepticus. The role of SPECT in differentiating PLEDs as an interictal or ictal pattern also requires further study.

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    • "LPDs is more controversial, as both focal hypo-and hyper-perfusion and metabolism have been described [Lee & Schauwecker, 1988; Ali et al., 2001; Assal et al., 2001; Bozkurt et al., 2002; Cury et al., 2004; Ergun et al., 2006; Kim et al., 2012]. This discrepancy between studies is likely attributable to the lack of control for the presence of seizures during or immediately before imaging, and to the presence and variable extent of an acute brain injury. "
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    ABSTRACT: The pathophysiological relation between periodic lateralized epileptiform discharges (PLEDs) and epileptic seizures is not known and the exact causative mechanism of PLEDs still remains unclear. In this report, the authors present a case in which the EEG displayed PLEDs after a complex partial seizure. This patient, with a long history of complex partial seizures, had previously undergone right standard anterior temporal lobectomy with hippocampectomy, with a diagnosis of mesial temporal sclerosis. She had one complex partial seizure 72 days after operation and was admitted to hospital. Her brain MRI revealed changes due to temporal lobectomy and small residual posterior hippocampic anomalies. PLEDs over the right temporal lobe were seen in postictal EEGs and persisted for 4 days despite the patient's normal mental status and normal neurologic examination. Brain perfusion scintigraphy with Tc-99m-HMPAO during PLEDs was performed on the second day after the seizure, and right temporal hyperperfusion was detected. EEGs and scintigraphic imaging were repeated after cessation of PLEDs. The repeated brain scan displayed right temporal hypoperfusion. PLEDs during the postictal period may actually be an ictal pattern, and if hyperperfusion in the brain SPECT studies during PLEDs is seen, further aggressive antiepileptic drug therapy may be necessary in some cases.
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