Periodic electroclinical seizures following an ischemic stroke revealed by continuous-EEG.
Continuous EEG monitoring
Cortical spreading depression
Periodic seizures
Post-stroke epilepsy
Journal
Epilepsy & behavior reports
ISSN: 2589-9864
Titre abrégé: Epilepsy Behav Rep
Pays: United States
ID NLM: 101750909
Informations de publication
Date de publication:
2021
2021
Historique:
received:
12
09
2020
revised:
15
12
2020
accepted:
17
12
2020
entrez:
5
3
2021
pubmed:
6
3
2021
medline:
6
3
2021
Statut:
epublish
Résumé
Periodic EEG patterns are mostly associated with critical illnesses and acute disruptions of the central nervous system. Periodic or cyclic seizures are extremely rare phenomena, most of which are nonconvulsive, only reported in critically ill patients. Here we report a patient with periodic focal impaired awareness seizures following a minor stroke and address possible pathophysiological mechanisms. A 49 years old male patient presented with periodic seizures, associated with an acute stroke in the left occipital and parietal regions. These focal seizures, recorded during long-term video-EEG monitoring in the scalp EEG, appeared every 9-11 min, and responded to iv valproic acid treatment but not to iv treatments of diazepam, phenytoin, and levetiracetam. We believe that the blood-brain barrier disruption due to stroke, in conjunction with hyperglycemia and antiphospholipid antibodies have led to an imbalance of the surrounding tissue and sustained hyperexcitability to a point of pacemaker potentials. It is tempting to speculate that repetitive cycles of cortical spreading depression due to tissue injury have aided the periodicity of the seizures. Continuous EEG monitoring is crucial, not only to diagnose and appropriately treat accompanying subtle seizures but also to further understand the underlying intriguing pathophysiological processes like periodicity.
Sections du résumé
BACKGROUND
BACKGROUND
Periodic EEG patterns are mostly associated with critical illnesses and acute disruptions of the central nervous system. Periodic or cyclic seizures are extremely rare phenomena, most of which are nonconvulsive, only reported in critically ill patients. Here we report a patient with periodic focal impaired awareness seizures following a minor stroke and address possible pathophysiological mechanisms.
CASE
METHODS
A 49 years old male patient presented with periodic seizures, associated with an acute stroke in the left occipital and parietal regions. These focal seizures, recorded during long-term video-EEG monitoring in the scalp EEG, appeared every 9-11 min, and responded to iv valproic acid treatment but not to iv treatments of diazepam, phenytoin, and levetiracetam.
DISCUSSION
CONCLUSIONS
We believe that the blood-brain barrier disruption due to stroke, in conjunction with hyperglycemia and antiphospholipid antibodies have led to an imbalance of the surrounding tissue and sustained hyperexcitability to a point of pacemaker potentials. It is tempting to speculate that repetitive cycles of cortical spreading depression due to tissue injury have aided the periodicity of the seizures.
CONCLUSION
CONCLUSIONS
Continuous EEG monitoring is crucial, not only to diagnose and appropriately treat accompanying subtle seizures but also to further understand the underlying intriguing pathophysiological processes like periodicity.
Identifiants
pubmed: 33665600
doi: 10.1016/j.ebr.2021.100428
pii: S2589-9864(21)00002-2
pmc: PMC7905351
doi:
Types de publication
Case Reports
Langues
eng
Pagination
100428Informations de copyright
© 2021 The Authors.
Références
J Clin Neurophysiol. 2013 Feb;30(1):1-27
pubmed: 23377439
Ann Neurol. 2011 May;69(5):892-900
pubmed: 21416487
J Cereb Blood Flow Metab. 2011 Jan;31(1):17-35
pubmed: 21045864
Epilepsia. 1997 Dec;38(12):1355-8
pubmed: 9578533
Brain. 2006 Dec;129(Pt 12):3224-37
pubmed: 17067993
J Neurophysiol. 1975 Jul;38(4):822-41
pubmed: 1159468
Epilepsia. 2011 Aug;52(8):1459-66
pubmed: 21668441
Neurologist. 2011 May;17(3):164-6
pubmed: 21532388
Clin Neurophysiol. 2008 Sep;119(9):1973-84
pubmed: 18621582
Br J Pharmacol. 1998 Dec;125(7):1610-6
pubmed: 9884091
Clin Neurophysiol. 2017 Jun;128(6):1083-1090
pubmed: 28214108
Epilepsia. 2008 Feb;49(2):281-7
pubmed: 17900293
J Clin Neurophysiol. 2020 May 7;:
pubmed: 32398513
Lupus. 2010 May;19(6):748-52
pubmed: 20133346
J Clin Neurophysiol. 2017 Jul;34(4):365-369
pubmed: 28166083
Ann Neurol. 2006 Apr;59(4):652-61
pubmed: 16450381
Epilepsia. 2012 Nov;53(11):1877-86
pubmed: 22905812
Eur J Neurol. 2019 Jan;26(1):18-e3
pubmed: 30320425
Exp Brain Res. 1983;51(2):291-7
pubmed: 6617798