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Focal cerebral metabolic abnormality in a patient with continuous spike waves during slow-wave sleep
Y D Park1, J M Hoffman, R A Radtke
1Department of Pediatrics (Neurology), Duke University Medical Center, Durham, NC.
Insights
This study details an 11-year-old boy with continuous spike-wave discharges during sleep, linked to secondary bilateral synchrony originating from the right temporoparietal region. Findings suggest potential effectiveness of surgical intervention for this epilepsy presentation.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neuroimaging
Background:
- Continuous spike-wave discharges during sleep (CSWS) can present with diverse neurological and behavioral symptoms.
- Secondary bilateral synchrony (SBS) is a hypothesized mechanism where focal epileptic activity generalizes.
- Understanding the origin of focal activity in CSWS is crucial for treatment.
Observation:
- An 11-year-old boy exhibited CSWS with partial motor and atypical absence seizures, psychomotor regression, and behavioral issues.
- Epileptiform discharges were localized to the right parietal region during wakefulness.
- Right-sided intracarotid amobarbital injection temporarily suppressed bilateral spike-and-wave activity.
Findings:
- [18F]fluorodeoxyglucose positron emission tomography revealed increased metabolic activity in the right superior temporoparietal region during epileptic discharges.
- These findings support a right temporoparietal epileptic focus underlying the observed CSWS and SBS.
- The patient's clinical presentation and neurophysiological/imaging data strongly indicate SBS secondary to a focal right temporoparietal abnormality.
Implications:
- The identification of a focal epileptic origin in this case of CSWS with SBS is significant.
- Surgical intervention targeting the identified right temporoparietal focus may be a viable therapeutic option.
- This case highlights the importance of detailed neuroimaging and neurophysiological evaluation in complex pediatric epilepsy syndromes.
Abstract:
We report an 11-year-old boy with continuous spike-wave discharges during sleep accompanied by partial motor and atypical absence seizures, psychomotor regression, and severe behavior problems. During wakefulness, epileptiform discharges occurred over the right parietal region, suggesting that the continuous spike-wave discharges during sleep were a manifestation of secondary bilateral synchrony. Bilateral suppression of the spike-and-wave activity was observed after right-sided intracarotid amobarbital injection, further supporting the impression of secondary bilateral synchrony. The right superior temporoparietal increase in metabolic activity during continuous spike-wave discharges and noncontinuous spike-wave discharges was seen on [18F]fluorodeoxyglucose positron emission tomography and supports a right temporoparietal focus in our case. The presence of a focal abnormality suggests that surgical therapy may be effective.