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Adversive seizures associated with periodic lateralised epileptiform discharges (PLEDs) after left orbital contusion

Takahiro Takeda1, Mikio Osawa, Sono Toi

  • 1Department of Neurology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan. ttakeda@nij.twmu.ac.jp

Epileptic Disorders : International Epilepsy Journal with Videotape
|December 19, 2012
PubMed

Insights

A patient experienced adversive seizures and periodic lateralised epileptiform discharges (PLEDs) after head trauma. Brain imaging revealed a contusion scar and abnormal metabolic activity in connected brain regions, suggesting cortical-subcortical dysfunction.

Area of Science:

  • Neurology
  • Neuroimaging
  • Epileptology

Background:

  • Head trauma can lead to delayed neurological complications, including seizures.
  • Periodic lateralised epileptiform discharges (PLEDs) are EEG abnormalities often associated with focal brain injury.
  • Adversive seizures involve involuntary motor activity and can be linked to focal cortical lesions.

Observation:

  • A patient presented with adversive seizures and PLEDs one month post-head trauma.
  • EEG showed left frontal PLEDs correlating with seizure onset.
  • Brain MRI revealed a left orbital cortex contusion scar with restricted diffusion extending to the ipsilateral thalamus.

Findings:

  • Single photon emission computed tomography (SPECT) demonstrated hyperperfusion in the left medial orbitofrontal cortex, basal ganglia, and thalamus.
  • Abnormal metabolism in the thalamus and striatum correlated with the orbital contusion.
  • Findings suggest trans-synaptic hyperactivity between cortical and subcortical structures.

Implications:

  • Subcortical structures may play a role in the generation of PLEDs and adversive seizures.
  • Understanding cortical-subcortical interactions is crucial for managing post-traumatic epilepsy.
  • Further research is needed to elucidate the mechanisms of PLEDs and seizure generation in this context.

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