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Prolonged deficits after focal inhibitory seizures

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Abstract

Introduction: Seizures are most commonly associated with positive phenomena such as tonic, clonic or myoclonic movements, automatisms, paresthesias and hallucinations. Negative phenomena, however, are not an uncommon manifestation of seizure activity. Examples of negative seizure phenomena include speech arrest, aphasia, amaurosis, amnesia, numbness, deafness, neglect and atonic seizures. Less commonly described in the literature are focal inhibitory motor seizures.

Methods and Results: Two patients presenting with rapidly progressive, prolonged hemiparesis, sensory neglect and hemi-visual field obscuration are described. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain did not reveal progression of known structural lesions or new lesions. The superficial cortex of the hemisphere contralateral to the hemiparesis and sensory neglect enhanced diffusely with gadolinium on T1-weighted MRI images. Electroencephalography demonstrated periodic lateralized epileptiform discharges (PLEDs) in one patient and lateralized suppression and slowing in the other patient. Single photon emission computed tomography (SPECT) revealed hyperperfusion in the hemisphere contralateral to the hemiparesis and sensory neglect. The changes seen on MRI and SPECT resolved with resolution of the symptoms.

Conclusion: Taken together with the clinical history, the results from these investigations suggest focal inhibitory seizure as the underlying etiology. A review of the literature and investigations helpful in making this difficult diagnosis are provided.

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References

  1. Wieshmann UC, Niehaus L, Meierkord H. Ictal speech arrest and parasagittal lesions. Eur Neurol 1997;38:123–127.

    PubMed  CAS  Google Scholar 

  2. Grimes DA, Guberman A. De novo aphasic status epilepticus. Epilepsia 1997;38:945–949.

    Article  PubMed  CAS  Google Scholar 

  3. Armon C, Radtke RA, Friedman AH. Inhibitory simple partial (non-convulsive) status epilepticus after intracranial surgery. J Neurol Neurosurg Psychiatry 2000;69:18–24.

    Article  PubMed  CAS  Google Scholar 

  4. Kolski H, Otsubo H. The Landau-Kleffner syndrome. Adv Exp Med Biol 2002;497:195–208.

    PubMed  Google Scholar 

  5. Meador KJ, Moser E. Negative seizures. J Int Neuropsychol Soc 2000;6:731–733.

    Article  PubMed  CAS  Google Scholar 

  6. Panayiotopoulos CP. Visual phenomena and headache in occipital epilepsy: a review, a systematic study and differentiation from migraine. Epileptic Disord 1999;1:205–216.

    PubMed  CAS  Google Scholar 

  7. Gokcay A, Gokcay F, Ekmekci O, Ulku A. Occipital epilepsies in children. Eur J Paediatr Neurol 2002;6:261–268.

    Article  PubMed  Google Scholar 

  8. Zeman AZ, Boniface SJ, Hodges JR. Transient epileptic amnesia: a description of the clinical and neuropsychological features in 10 cases and a review of the literature. J Neurol Neurosurg Psychiatry 1998;64:435–443.

    PubMed  CAS  Google Scholar 

  9. Rowan AJ, Rosenbaum DH. Ictal amnesia and fugue states. Adv Neurol 1991;55:357–367.

    PubMed  CAS  Google Scholar 

  10. Blume WT, Jones DC, Young GB, Girvin JP, McLachlan RS. Seizures involving secondary sensory and related areas. Brain 1992;115:1509–1520.

    Article  PubMed  Google Scholar 

  11. Ghosh D, Mohanty G, Prabhakar S. Ictal deafness—a report of three cases. Seizure 2001;10:130–133.

    PubMed  CAS  Google Scholar 

  12. Heilman KM, Howell GJ. Seizure-induced neglect. J Neurol Neurosurg Psychiatry 1980;43:1035–1040.

    Article  PubMed  CAS  Google Scholar 

  13. Fisher CM. Transient paralytic attacks of obscure nature: the question of non-convulsive seizure paralysis. Can J Neurol Sci 1978;5:267–273.

    PubMed  CAS  Google Scholar 

  14. Blume WT. Physiology of atonic seizures. Adv Neurol 1995;67:173–179.

    PubMed  CAS  Google Scholar 

  15. Gowers WR. Epilepsy and other chronic convulsive disease. New York: Williams Wood & Company, 1885.

    Google Scholar 

  16. Higier H. A paralytic equivalent of genuine epilepsy. D Z NervHeilk 1916;55:95–100.

    Article  Google Scholar 

  17. Penfield WG, Jasper HH. Epilepsy and functional anatomy of the human brain. Boston: Little, Brown, 1954.

    Google Scholar 

  18. Kofman O, Tasker R. Ipsilateral and focal inhibitory seizures. Neurology 1967;17:1082–1086.

    PubMed  CAS  Google Scholar 

  19. Gastaut H, Broughton R. Epileptic seizures, clinical and electrographic features, diagnosis and treatment. Springfield: Thomas, 1972.

    Google Scholar 

  20. Hanson PA, Chodos R. Hemiparetic seizures. Neurology 1978;28:920–923.

    PubMed  CAS  Google Scholar 

  21. Globus M, Lavi E, Fich A, Abramsky O. Ictal hemiparesis. Eur Neurol 1982;21:165–168.

    PubMed  CAS  Google Scholar 

  22. Tinuper P, Aguglia U, Laudadio S, Gastaut H. Prolonged ictal paralysis: electroencephalographic confirmation of its epileptic nature. Clin Electroencephalogr 1987;18:12–14.

    PubMed  CAS  Google Scholar 

  23. Smith RF, Devinsky O, Luciano D. Inhibitory motor status: two new cases and a review of inhibitory motor seizures. J Epilepsy 1997;10:15–21.

    Article  Google Scholar 

  24. Dale RC, Cross JH. Ictal hemiparesis. Dev Med Child Neurol 1999;41:344–347.

    Article  PubMed  CAS  Google Scholar 

  25. Cutrer FM, O’Donnell A, Sanchez DR. Functional neuroimaging: enhanced understanding of migraine pathophysiology. Neurology 2000;55:S36-S45.

    PubMed  CAS  Google Scholar 

  26. De Benedittis G, Ferrari DP, Granata G, Lorenzetti A. CBF changes during headache-free periods and spontaneous/induced attacks in migraine with and without aura: a TCD and SPECT comparison study. J Neurosurg Sci 1999;43:141–146.

    PubMed  Google Scholar 

  27. Horowitz SW, Merchut M, Fine M, Azar-Kia B. Complex partial seizure-induced transient MR enhancement. J Comput Assist Tomogr 1992;16:814–816.

    Article  PubMed  CAS  Google Scholar 

  28. Henry TR, Drury I, Brunberg JA, Pennell PB, McKeever PE, Beydoun A. Focal cerebral magnetic resonance changes associated with partial status epilepticus. Epilepsia 1994;35:35–41.

    Article  PubMed  CAS  Google Scholar 

  29. Helpern JA, Huang N. Diffusion-weighted imaging in epilepsy. Magn Reson Imaging 1995;13:1227–1231.

    Article  PubMed  CAS  Google Scholar 

  30. Wieshmann UC, Symms MR, Shorvon SD. Diffusion changes in status epilepticus. Lancet 1997;350:493,494.

    Article  PubMed  CAS  Google Scholar 

  31. Sitoh YY, Tien RD. Neuroimaging in epilepsy. J Magn Reson Imaging 1998;8:277–288.

    Article  PubMed  CAS  Google Scholar 

  32. Prichard JW, Neil JJ. Diffusion-weighted MRI: periictal studies. Adv Neurol 2000;83:279–284.

    PubMed  CAS  Google Scholar 

  33. Kim JA, Chung JI, Yoon PH, et al. Transient MR signal changes in patients with generalized tonic-clonic seizure or status epilepticus: periictal diffusion-weighted imaging. AJNR 2001;22:1149–1160.

    PubMed  CAS  Google Scholar 

  34. Marchal G, Young AR, Baron JC. Early post-ischemic hyperperfusion: pathophysiologic insights from positron emission tomography. J Cereb Blood Flow Metab 1999;19:467–482.

    Article  PubMed  CAS  Google Scholar 

  35. Berkovic SF. SPECT: Neurobiology of periictal blood flow alterations. Adv Neurol 2000;83:33–39.

    PubMed  CAS  Google Scholar 

  36. Baykan B, Kinay D, Gokyigit A, Gurses C. Periodic lateralized epileptiform discharges: association with seizures. Seizure 2000;9:402–406.

    Article  PubMed  CAS  Google Scholar 

  37. Bozkurt MF, Saygi S, Erbas B. SPECT in a patient with postictal PLEDs: is hyperperfusion evidence of electrical seizure? Clin Electroencephalogr 2002;33:171–173.

    PubMed  Google Scholar 

  38. Penfield WG, Rasmussen TB. The cerebral cortex of man. New York: MacMillan, 1950.

    Google Scholar 

  39. Luders H, Lesser RP, Dinner DS, Hahn JF, Salanga V, Morris HH. The second sensory area in humans: evoked potential and electrical stimulation studies. Ann Neurol 1985;17:177–184.

    Article  PubMed  CAS  Google Scholar 

  40. Luders HO, Dinner DS, Morris HH, Wyllie E, Comair YG. Cortical electrical stimulation in humans. The negative motor areas. Adv Neurol 1995;67:115–129.

    PubMed  CAS  Google Scholar 

  41. Ikeda A, Ohara S, Matsumoto R, et al. Role of primary sensorimotor cortices in generating inhibitory motor response in humans. Brain 2000;123:1710–1721.

    Article  PubMed  Google Scholar 

  42. Matsumoto R, Ikeda A, Ohara S, et al. Nonconvulsive focal inhibitory seizure: subdural recording from motor cortex. Neurology 2000;55:429–431.

    PubMed  CAS  Google Scholar 

  43. Todd RB. Clinical lectures on paralysis, Disease of the brain and other affections of the nervous system. 2nd ed., London: Churchill, 1856.

    Google Scholar 

  44. Efron R. Post-epileptic paralysis: theoretical critique and report of a case. Brain 1961;84:381–394.

    Article  PubMed  CAS  Google Scholar 

  45. Oestreich LJ, Berg MJ, Bachmann DL, Burchfiel J, Erba G. Ictal contralateral paresis in complex partial seizures. Epilepsia 1995;36:671–675.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Neurological Sciences, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada

    Miguel Bussière & G. Bryan Young MD, FRCPC

  2. Department of Diagnostic Radiology, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada

    David Pelz

  3. Department of Nuclear Medicine, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada

    Robert H Reid

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  1. Miguel Bussière
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  2. David Pelz
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  3. Robert H Reid
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  4. G. Bryan Young MD, FRCPC
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Correspondence to G. Bryan Young MD, FRCPC.

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Bussière, M., Pelz, D., Reid, R.H. et al. Prolonged deficits after focal inhibitory seizures. Neurocrit Care 2, 29–37 (2005). https://doi.org/10.1385/NCC:2:1:029

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