Prolonged deficits after focal inhibitory seizures

Area of Science:

• Neurology
• Epileptology

Background:

• Seizures typically manifest as positive phenomena (e.g., movements, hallucinations).
• Negative seizure phenomena (e.g., speech arrest, sensory loss) are less common but significant.
• Focal inhibitory motor seizures are rarely described in medical literature.

Observation:

• Two patients presented with progressive hemiparesis, sensory neglect, and visual field obscuration.
• Brain imaging (CT, MRI) showed no new lesions, but diffuse cortical enhancement was noted.
• EEG revealed periodic lateralized epileptiform discharges or lateralized suppression and slowing.
• SPECT scans indicated hyperperfusion in the affected hemisphere.

Findings:

• Clinical presentation, imaging, and EEG/SPECT findings suggested focal inhibitory seizures.
• Neurological deficits and imaging/SPECT abnormalities resolved with symptom resolution.
• These findings highlight a distinct presentation of seizure activity.

Implications:

• Recognizing focal inhibitory seizures is crucial for accurate diagnosis and management.
• Advanced neuroimaging (MRI, SPECT) and electroencephalography (EEG) are vital for diagnosis.
• This case series contributes to understanding the spectrum of seizure manifestations and their underlying pathophysiology.