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Prolonged ictal monoparesis with parietal Periodic Lateralised Epileptiform Discharges (PLEDs)

Takashi Murahara1, Masako Kinoshita, Kiyohide Usami

  • 1Department of Neurology, Graduate School of Medicine, Kyoto University, Sakyoku, Japan.

Epileptic Disorders : International Epilepsy Journal with Videotape
|June 19, 2013
PubMed

Insights

A patient with chronic myelomonocytic leukemia experienced prolonged right arm weakness and speech difficulties. Periodic lateralized epileptiform discharges (PLEDs) on EEG resolved with phenytoin, improving neurological symptoms.

Area of Science:

  • Neurology
  • Epileptology
  • Hematology

Background:

  • Chronic myelomonocytic leukemia (CMML) can present with diverse neurological complications.
  • Periodic lateralized epileptiform discharges (PLEDs) are EEG findings often associated with focal brain injury or dysfunction.

Observation:

  • A 73-year-old male with CMML developed persistent right arm monoparesis, sensory aphasia, and finger agnosia.
  • Initial presentation included focal clonic seizures, followed by persistent neurological deficits for seven days.
  • Electroencephalography (EEG) revealed left-sided PLEDs, predominantly in the left occipito-parietal region.

Findings:

  • Phenytoin treatment led to a sudden improvement in the patient's neurological deficits.
  • Parietal PLEDs on EEG resolved concurrently with symptom improvement.
  • The sustained PLEDs in the left parietal region were hypothesized to be causally linked to the ictal paresis.

Implications:

  • This case suggests a potential causal relationship between sustained parietal PLEDs and prolonged focal neurological deficits, such as monoparesis.
  • Effective management of PLEDs may lead to resolution of associated neurological impairments.
  • Highlights the importance of EEG monitoring in patients with CMML presenting with neurological symptoms.
Keywords:
EEGPLEDsinhibitory motor seizure

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