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Changing patterns of propagation in a super-refractory status of the temporal lobe. Over 900 seizures recorded over nearly one year.

Napolitano CE, Orriols MA - Epilepsy Behav Case Rep (2013)

Bottom Line: Our goals were to study the propagation models in a situation of persistent temporal epileptic seizures with varying degrees of bitemporal excitability and to analyze which propagation models were found at times of high temporal excitability and which occurred with lower levels of excitability.From the beginning, the interictal recording showed independent discharges over both temporal lobes.The analysis of the propagation models may provide information about the excitability of the mesial temporal-limbic network.

View Article: PubMed Central - PubMed

Affiliation: Neurology Service, Electroencephalography Department, Military Hospital, Santiago, Chile.

ABSTRACT

Objective: Our goals were to study the propagation models in a situation of persistent temporal epileptic seizures with varying degrees of bitemporal excitability and to analyze which propagation models were found at times of high temporal excitability and which occurred with lower levels of excitability.

Methods: A patient with super-refractory status arising from the temporal lobes was studied daily using video-electroencephalography (VEEG), with a large number of electroclinical seizures recorded. The analysis focused on the method and type of seizure propagation and classified them either according to the propagation models described in the literature or as undetermined.

Results: Video-EEG monitoring was carried out daily for 310 days. A total of 990 electroclinical seizures were recorded; 135 seizures were recorded during the first week, and 523 were recorded in the first month. From the beginning, the interictal recording showed independent discharges over both temporal lobes. The seizures showed independent onset in both temporal lobes. During periods of the highest number of seizures, certain models of propagation begin to predominate through switch of lateralization, temporal asynchrony, early remote propagation, total contralateral propagation, seizures with nonlocalized onset, or models that are difficult to classify. Conversely, when the condition was brought relatively under control, we observed fewer propagation models with predominantly simple patterns: only hemispheric propagation or graduated sequential propagation with a few nonlateralized onset seizures.

Conclusions: Upon analyzing the seizures, we found that the propagation models vary as the status evolved, with the change reflecting the degree of excitability in the mesial temporal-limbic network at a given time. In clinical practice, these changes in propagation models are more likely to be observed in temporal status that extends over time and with an onset of the seizures in both temporal lobes.

Significance: The analysis of the propagation models may provide information about the excitability of the mesial temporal-limbic network.

No MeSH data available.


Related in: MedlinePlus

MRI FLAIR sequence (A: axial view, B: coronal view) on Day 6 demonstrating bilateral medial temporal lobe hyperintensity.
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f0005: MRI FLAIR sequence (A: axial view, B: coronal view) on Day 6 demonstrating bilateral medial temporal lobe hyperintensity.

Mentions: The patient is a 23-year-old male with no previous medical history who, four days prior to being admitted to our hospital, began to suffer persistent headaches accompanied with fever and followed by generalized convulsive seizures; the seizures recurred several times in the following 48 h. Treatment began with intravenous (IV) phenytoin, valproic acid IV, and then a continuous infusion of midazolam. As the convulsive seizures persisted, the patient was transferred to the ICU. The cerebrospinal fluid (CSF) study was normal; screening was done for infectious agents in CSF and blood, both of which were negative. Empirical treatment with acyclovir was then begun, with no change observed in the patient's clinical condition. An initial magnetic nuclear resonance (MNR) study with T2, T1, and FLAIR sequences showed a slight hyperintensity at the bilateral mesial temporal level with a slight thalamic hyperintensity; subsequent tests showed heightened bilateral mesial hyperintensity with the thalamic hyperintensity disappearing (Fig. 1). Magnetic nuclear resonance imaging one to seven months afterward showed disappearance of the mesial hyperintensity but revealed cortical atrophy, especially in the bilateral temporal areas. Serological screening for systemic autoimmune diseases was negative, including ANA, anti-dsDNA, complement (C3/C4), antiphospholipid antibodies, ANCA, and Sjögren's antibodies. Increased antithyroglobulin antibodies were found with normal peroxidase antibodies. Testing for autoantibodies targeting VGKC-complex GAD and onconeural antigens (e.g., Hu Abs, Ma2 Abs, CV2/CRMP5 Abs) was negative (Mayo Clinic Dept. of Lab Med & Pathology). A whole-body computed tomography scan revealed no occult malignancy.


Changing patterns of propagation in a super-refractory status of the temporal lobe. Over 900 seizures recorded over nearly one year.

Napolitano CE, Orriols MA - Epilepsy Behav Case Rep (2013)

MRI FLAIR sequence (A: axial view, B: coronal view) on Day 6 demonstrating bilateral medial temporal lobe hyperintensity.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150637&req=5

f0005: MRI FLAIR sequence (A: axial view, B: coronal view) on Day 6 demonstrating bilateral medial temporal lobe hyperintensity.
Mentions: The patient is a 23-year-old male with no previous medical history who, four days prior to being admitted to our hospital, began to suffer persistent headaches accompanied with fever and followed by generalized convulsive seizures; the seizures recurred several times in the following 48 h. Treatment began with intravenous (IV) phenytoin, valproic acid IV, and then a continuous infusion of midazolam. As the convulsive seizures persisted, the patient was transferred to the ICU. The cerebrospinal fluid (CSF) study was normal; screening was done for infectious agents in CSF and blood, both of which were negative. Empirical treatment with acyclovir was then begun, with no change observed in the patient's clinical condition. An initial magnetic nuclear resonance (MNR) study with T2, T1, and FLAIR sequences showed a slight hyperintensity at the bilateral mesial temporal level with a slight thalamic hyperintensity; subsequent tests showed heightened bilateral mesial hyperintensity with the thalamic hyperintensity disappearing (Fig. 1). Magnetic nuclear resonance imaging one to seven months afterward showed disappearance of the mesial hyperintensity but revealed cortical atrophy, especially in the bilateral temporal areas. Serological screening for systemic autoimmune diseases was negative, including ANA, anti-dsDNA, complement (C3/C4), antiphospholipid antibodies, ANCA, and Sjögren's antibodies. Increased antithyroglobulin antibodies were found with normal peroxidase antibodies. Testing for autoantibodies targeting VGKC-complex GAD and onconeural antigens (e.g., Hu Abs, Ma2 Abs, CV2/CRMP5 Abs) was negative (Mayo Clinic Dept. of Lab Med & Pathology). A whole-body computed tomography scan revealed no occult malignancy.

Bottom Line: Our goals were to study the propagation models in a situation of persistent temporal epileptic seizures with varying degrees of bitemporal excitability and to analyze which propagation models were found at times of high temporal excitability and which occurred with lower levels of excitability.From the beginning, the interictal recording showed independent discharges over both temporal lobes.The analysis of the propagation models may provide information about the excitability of the mesial temporal-limbic network.

View Article: PubMed Central - PubMed

Affiliation: Neurology Service, Electroencephalography Department, Military Hospital, Santiago, Chile.

ABSTRACT

Objective: Our goals were to study the propagation models in a situation of persistent temporal epileptic seizures with varying degrees of bitemporal excitability and to analyze which propagation models were found at times of high temporal excitability and which occurred with lower levels of excitability.

Methods: A patient with super-refractory status arising from the temporal lobes was studied daily using video-electroencephalography (VEEG), with a large number of electroclinical seizures recorded. The analysis focused on the method and type of seizure propagation and classified them either according to the propagation models described in the literature or as undetermined.

Results: Video-EEG monitoring was carried out daily for 310 days. A total of 990 electroclinical seizures were recorded; 135 seizures were recorded during the first week, and 523 were recorded in the first month. From the beginning, the interictal recording showed independent discharges over both temporal lobes. The seizures showed independent onset in both temporal lobes. During periods of the highest number of seizures, certain models of propagation begin to predominate through switch of lateralization, temporal asynchrony, early remote propagation, total contralateral propagation, seizures with nonlocalized onset, or models that are difficult to classify. Conversely, when the condition was brought relatively under control, we observed fewer propagation models with predominantly simple patterns: only hemispheric propagation or graduated sequential propagation with a few nonlateralized onset seizures.

Conclusions: Upon analyzing the seizures, we found that the propagation models vary as the status evolved, with the change reflecting the degree of excitability in the mesial temporal-limbic network at a given time. In clinical practice, these changes in propagation models are more likely to be observed in temporal status that extends over time and with an onset of the seizures in both temporal lobes.

Significance: The analysis of the propagation models may provide information about the excitability of the mesial temporal-limbic network.

No MeSH data available.


Related in: MedlinePlus