Chronic PLEDs with transitional rhythmic discharges (PLEDs-plus) in remote stroke

Area of Science:

• Neurology
• Neurophysiology
• Epileptology

Background:

• Periodic lateralized epileptiform discharges (PLEDs) are typically transient EEG findings associated with acute brain lesions.
• Persistent PLEDs in chronic lesions are rare, with limited case reports available.
• Understanding PLEDs' chronicity is crucial for managing epilepsy secondary to brain injury.

Observation:

• An 86-year-old female with a remote left middle cerebral artery (MCA) stroke presented with recurrent focal motor seizures.
• Electroencephalography (EEG) revealed persistent PLEDs-plus (PLEDs with rhythmic discharges) over the left hemisphere across multiple recordings from 2002 to 2006.
• The patient experienced sequential complex partial seizures consistent with the observed EEG pattern.

Findings:

• This report details an unusual case of chronic PLEDs-plus associated with rhythmic discharges.
• The PLEDs-plus pattern persisted for at least four years following the initial acute stroke.
• The chronic PLEDs were linked to recurrent seizure activity in the patient.

Implications:

• This case expands the understanding of PLEDs' potential for chronicity in remote structural brain lesions.
• It suggests that chronic PLEDs may serve as a substrate for ongoing seizure generation.
• Further research into the mechanisms and long-term management of chronic PLEDs is warranted.