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Periodic lateralized epileptiform discharges in multiple sclerosis: a case report
R Gandelman-Marton1, J M Rabey, S Flechter
1The EEG Lab, Assaf-Harofeh Medical Center, Zerifin, Israel.
Summary
Epileptiform abnormalities on EEG are rare in multiple sclerosis (MS). This case highlights seizures and confusion in an MS patient, correlating EEG, MRI, and SPECT findings with disease exacerbation.
Area of Science:
- Neuroscience
- Neurology
- Clinical Neurophysiology
Background:
- Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system.
- Epileptiform abnormalities on electroencephalogram (EEG) are infrequently reported in MS patients.
- Focal motor seizures and altered consciousness are uncommon presenting symptoms in MS exacerbations.
Observation:
- A 44-year-old female with a history of relapsing-remitting and secondary progressive MS presented with acute focal motor seizures and confusion.
- Electroencephalogram (EEG) revealed periodic lateralized epileptiform discharges in the right temporal region.
- Brain magnetic resonance imaging (MRI) showed scattered T2 hyperintensities, and brain single photon emission computed tomography (SPECT) demonstrated decreased perfusion in the right parietal and temporal lobes.
Findings:
- The clinical presentation of focal motor seizures and confusion was associated with specific neurophysiological and imaging findings.
- Periodic lateralized epileptiform discharges on EEG indicated focal cerebral dysfunction.
- Reduced regional cerebral perfusion in the right parietal and temporal lobes on SPECT suggested localized hypometabolism or ischemia.
Implications:
- This case suggests that acute seizures and transiently altered consciousness can manifest as a result of MS exacerbation.
- The findings underscore the importance of correlating clinical symptoms with EEG, MRI, and SPECT in diagnosing and understanding MS-related neurological events.
- Periodic lateralized epileptiform discharges and decreased regional perfusion on SPECT may represent the neurophysiologic signature of MS relapses manifesting as seizures.