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Bilateral spike-and-wave discharges in a hemi-deafferented cortex
M Inghilleri1, A Clemenzi, A Conte
1Department of Neurological Sciences, University of Rome, Rome, Italy. maurizio.inghilleri@uniroma1.it
Summary
A patient experienced absence status epilepticus with bilateral spike-and-wave discharges following a top-of-the-basilar syndrome. Treatment with sodium valproate normalized electroencephalographic recordings and consciousness.
Area of Science:
- Neurology
- Epileptology
- Neurophysiology
Background:
- Absence status epilepticus is a rare neurological condition characterized by continuous absence seizures.
- Top-of-the-basilar syndrome can result from various cerebrovascular events affecting the upper brainstem and thalamic regions.
Observation:
- A patient with a history of childhood absence attacks developed absence status epilepticus.
- The condition manifested with bilateral spike-and-wave discharges on electroencephalography (EEG) after a top-of-the-basilar syndrome.
- Despite an ischemic lesion confined to the left thalamus, bilateral EEG abnormalities were observed.
Findings:
- The study documents a case of absence status epilepticus with bilateral EEG abnormalities originating from a unilateral thalamic ischemic lesion.
- Prompt initiation of antiepileptic drug therapy, specifically sodium valproate, led to rapid clinical and electrophysiological improvement.
Implications:
- This case highlights the potential for unilateral thalamic lesions to trigger bilateral epileptic discharges, suggesting complex interhemispheric network involvement in absence seizures.
- It underscores the efficacy of sodium valproate in managing absence status epilepticus.
- Further research into the neurophysiological mechanisms underlying thalamocortical dysrhythmia in post-stroke epilepsy is warranted.