Intracranial Cortical Calcifications in a Focal Epilepsy Patient with Pseudohypoparathyroidism

Patients with chronic parathyroid dysfunction often have intracranial calcification in deep gray matter (GM) and subcortical white matter (WM) of their brain. Some of them are also epilepsy patients. Although cortical etiologies are main cause of epileptic seizure, cortical calcification has not been reported in these patients. We report a newly diagnosed focal epilepsy patient whose brain magnetic resonance imaging revealed intracranial calcifications in cortical as well as subcortical areas. Blood lab revealed that he had hypocalcemia due to pseudohypoparathyroidism. Video EEG monitoring revealed the ictal EEG mainly consist of polymorphic delta to theta waves with maximum at right temporal area followed by background attenuation and muscle artifacts. The interictal EEG showed multiple focal spike-wave discharges. After given oral calcium and calcitriol supplement, his calcium and phosphorous level normalized and he remains seizure free. This is the first case to show cortical calcification in a patient with pseudohypoparathyroidism. Cortical calcification could be an important measure of seizure burden in these patients and thus sophisticated imaging protocols should be used to visualize the extent of calcium deposits.