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Periodic lateralized epileptiform discharges in multiple sclerosis
D R Chabolla1, J L Moore, B F Westmoreland
1Division of Clinical Neurophysiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Abstract:
We report an unusual cause of periodic lateralized epileptiform discharges (PLEDs) in a young man with a long history of multiple sclerosis. Two exacerbations of multiple sclerosis, 3 years apart, were complicated by complex partial status epilepticus. After each episode, serial electroencephalograms revealed PLEDs (right frontal PLEDs in the first episode and right frontotemporal and bifrontal PLEDs in the second one), which resolved within 2 weeks. With the first episode, magnetic resonance imaging revealed an enhancing white matter lesion in the right frontal area, which improved after 3 weeks. We concluded that in each instance an exacerbation of multiple sclerosis caused the seizures.
Insights
Multiple sclerosis exacerbations can trigger complex partial status epilepticus and periodic lateralized epileptiform discharges (PLEDs) in young adults. These PLEDs resolve within two weeks, linked to white matter lesions.
Area of Science:
- Neurology
- Neurophysiology
- Neuroimmunology
Background:
- Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system.
- Seizures are a known neurological complication of MS, but their specific electroencephalographic (EEG) manifestations can vary.
- Periodic lateralized epileptiform discharges (PLEDs) are typically associated with acute focal brain injury.
Observation:
- A young male patient with a history of MS experienced two episodes of complex partial status epilepticus separated by three years.
- Following each status epilepticus episode, serial EEGs demonstrated PLEDs, initially right frontal and later right frontotemporal and bifrontal.
- Magnetic resonance imaging (MRI) revealed an enhancing white matter lesion in the right frontal lobe during the first episode, which showed improvement over time.
Findings:
- The study identified exacerbations of MS as an unusual cause of PLEDs.
- The PLEDs observed in this patient resolved spontaneously within two weeks after each seizure episode.
- The occurrence of PLEDs correlated with MS exacerbations and associated focal brain lesions.
Implications:
- This case highlights the importance of considering MS exacerbations in the differential diagnosis of PLEDs, especially in patients with a known history of the disease.
- Understanding the link between MS activity and specific EEG patterns like PLEDs can aid in diagnosis and management.
- Further research may elucidate the mechanisms by which MS exacerbations lead to acute epileptiform activity.