Periodic lateralized epileptiform discharges after complex partial status epilepticus associated with increased focal cerebral blood flow.
ABSTRACT 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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ABSTRACT: The goal of this report is to review periodic lateralized epileptiform discharges (PLEDs), particularly their associated symptoms, the possibility that the pattern represents a focal status epilepticus, and finally the usefulness of antiepileptic drugs (AEDs). The associated symptoms often include an "altered state of consciousness" or "confusional state," but also more specific symptoms have been noted, such as nystagmus retractorius, cortical blindness, depression, apraxia, amnesia, hemianopsia, hemiparesis, gaze preference or deviation, dysphasia, and speech impediment. PLEDs have often been referred to as an ictal pattern, and many investigators have viewed the condition an example of subclinical status epilepticus. The intense hypermetabolism and increased blood flow revealed by PET and SPECT scans have been considered to support the ictal nature of this waveform. Although the pattern is difficult to treat, the AEDs that have been reported as successful include carbamazepine, midazolam, pentobarbital, sodium valproate, and felbamate. As only subtle symptoms are, at times, present and therefore may be missed and the pattern is known to be difficult to treat, epileptologists who view the PLED pattern as only an EEG curiosity and decide against treatment may wish to reevaluate the electroclinical evidence related to this interesting and significant pattern.Epilepsy & Behavior 07/2010; 18(3):162-5. · 2.06 Impact Factor
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ABSTRACT: Periodic lateralized epileptiform discharges are associated with a variety of acute neurological disorders such as stroke, encephalitis and intracerebral hemorrhage. This particular EEG pattern may also be seen in association with status epilepticus. There is a debate in the neurology literature whether this pattern represents ongoing seizure activity or is an interictal pattern. Researchers are now beginning to utilize functional imaging studies such as SPECT to help differentiate whether this EEG pattern is ictal or interictal. This chapter provides an overview of the current state of literature regarding this topic.12/2004: pages 193-197;
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ABSTRACT: Periodic epileptiform discharges (PEDs) are a frequent finding in comatose patients undergoing continuous EEG (cEEG) monitoring, but their clinical significance is unclear. PET and SPECT studies indicate that PEDs can be associated with focal hypermetabolism and hyperemia, suggesting that in some cases this pattern may be ictal and potentially harmful. We hypothesized that frequent PED activity in comatose patients is associated with reduced likelihood of recovery of consciousness. We identified all comatose patients treated in the Columbia neuro-ICU between June 2008 and August 2009 who underwent ten or more consecutive days of video cEEG monitoring (N = 67), and classified them into three groups: those with (1) prolonged PEDs (five or more consecutive days), (2) intermittent PEDs (at least one but fewer than five consecutive days), and (3) no PEDs. Outcome at discharge was assessed by the Glasgow Outcome Scale and classified as dead (GOS 1), vegetative (GOS 2), and command-following (GOS 3-5). Mean age was 56 years, mean admission Glasgow Coma Scale score was seven, and the median duration of cEEG monitoring was 18 (range 10-111) days. The most common diagnoses were hypoxic-ischemic encephalopathy (18%), subarachnoid hemorrhage (16%), epilepsy (15%), encephalitis (15%), metabolic encephalopathy (13%), and intracerebral hemorrhage (12%). 37% of patients (N = 25) had prolonged PEDs, 31% (N = 21) had intermittent PEDs, and 31% (N = 21) had no PEDs. Prolonged PEDs were associated with the presence of SIRPIDS (P = 0.009), electrographic seizures (P = 0.019), and number of AEDs administered (P < 0.0001). However, the presence of intermittent or prolonged PED activity had no impact on mortality (31% overall) or recovery of consciousness (command-following) at the time of discharge (36% overall). Persistent spontaneous PED activity in comatose patients is associated with SIRPIDs and electrographic seizures, but has no impact on the likelihood of survival or recovery of consciousness.Neurocritical Care 06/2012; 17(1):39-44. · 3.04 Impact Factor