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Bitemporal independent 3-Hz spike-and-waves in adult patient with idiopathic generalized epilepsy and Graves disease

OBJECTIVE: We present a case of idiopathic generalized epilepsy (IGE) with seizures manifesting in the context of Graves disease and unusual interictal EEG pattern of bilateral independent 3 Hz spike and wave activity. CASE REPORT: A 33-year old man with three generalized tonic-clonic seizures (GTCS...

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Autores principales: Broutian, Amayak, Dolgova, Snezhana, Belyakova-Bodina, Alexandra, Abramova, Anna, Lukianova, Anastasia, Noskova, Tatiana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599360/
https://www.ncbi.nlm.nih.gov/pubmed/33150271
http://dx.doi.org/10.1016/j.cnp.2020.09.001
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author Broutian, Amayak
Dolgova, Snezhana
Belyakova-Bodina, Alexandra
Abramova, Anna
Lukianova, Anastasia
Noskova, Tatiana
author_facet Broutian, Amayak
Dolgova, Snezhana
Belyakova-Bodina, Alexandra
Abramova, Anna
Lukianova, Anastasia
Noskova, Tatiana
author_sort Broutian, Amayak
collection PubMed
description OBJECTIVE: We present a case of idiopathic generalized epilepsy (IGE) with seizures manifesting in the context of Graves disease and unusual interictal EEG pattern of bilateral independent 3 Hz spike and wave activity. CASE REPORT: A 33-year old man with three generalized tonic-clonic seizures (GTCS) in history admitted for overnight video-EEG. At the age of 28, he had his first seizure soon after being diagnosed with Graves' disease. For four years, he received thiamazole and then underwent total thyroidectomy. EEG showed a high number of generalized 3-Hz spike-and-wave discharges (GSWD) but also revealed numerous runs of bitemporal independent lateralized 3-Hz spike-and-wave activity (LSWA). GSWD and LSWA were mostly independent and had slightly different morphology. A diagnosis of IGE with GTCS upon awakening was made. On levetiracetam therapy, the patient demonstrated no seizure recurrence during 2-year follow-up. Repeated overnight EEG showed significant GSWD reduction and complete LSWA suppression. DISCUSSION: To our knowledge, in patients with IGE, strictly lateralized spike-and-wave activity was never reported. In this case, thyroid dysfunction seemed to increase propensity to generate spontaneous seizures. We speculate that thyroid dysfunction superimposed on IGE thalamocortical network oscillations resulted in uncommon bitemporal independent LSWA.
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spelling pubmed-75993602020-11-03 Bitemporal independent 3-Hz spike-and-waves in adult patient with idiopathic generalized epilepsy and Graves disease Broutian, Amayak Dolgova, Snezhana Belyakova-Bodina, Alexandra Abramova, Anna Lukianova, Anastasia Noskova, Tatiana Clin Neurophysiol Pract Case Report OBJECTIVE: We present a case of idiopathic generalized epilepsy (IGE) with seizures manifesting in the context of Graves disease and unusual interictal EEG pattern of bilateral independent 3 Hz spike and wave activity. CASE REPORT: A 33-year old man with three generalized tonic-clonic seizures (GTCS) in history admitted for overnight video-EEG. At the age of 28, he had his first seizure soon after being diagnosed with Graves' disease. For four years, he received thiamazole and then underwent total thyroidectomy. EEG showed a high number of generalized 3-Hz spike-and-wave discharges (GSWD) but also revealed numerous runs of bitemporal independent lateralized 3-Hz spike-and-wave activity (LSWA). GSWD and LSWA were mostly independent and had slightly different morphology. A diagnosis of IGE with GTCS upon awakening was made. On levetiracetam therapy, the patient demonstrated no seizure recurrence during 2-year follow-up. Repeated overnight EEG showed significant GSWD reduction and complete LSWA suppression. DISCUSSION: To our knowledge, in patients with IGE, strictly lateralized spike-and-wave activity was never reported. In this case, thyroid dysfunction seemed to increase propensity to generate spontaneous seizures. We speculate that thyroid dysfunction superimposed on IGE thalamocortical network oscillations resulted in uncommon bitemporal independent LSWA. Elsevier 2020-10-14 /pmc/articles/PMC7599360/ /pubmed/33150271 http://dx.doi.org/10.1016/j.cnp.2020.09.001 Text en © 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Broutian, Amayak
Dolgova, Snezhana
Belyakova-Bodina, Alexandra
Abramova, Anna
Lukianova, Anastasia
Noskova, Tatiana
Bitemporal independent 3-Hz spike-and-waves in adult patient with idiopathic generalized epilepsy and Graves disease
title Bitemporal independent 3-Hz spike-and-waves in adult patient with idiopathic generalized epilepsy and Graves disease
title_full Bitemporal independent 3-Hz spike-and-waves in adult patient with idiopathic generalized epilepsy and Graves disease
title_fullStr Bitemporal independent 3-Hz spike-and-waves in adult patient with idiopathic generalized epilepsy and Graves disease
title_full_unstemmed Bitemporal independent 3-Hz spike-and-waves in adult patient with idiopathic generalized epilepsy and Graves disease
title_short Bitemporal independent 3-Hz spike-and-waves in adult patient with idiopathic generalized epilepsy and Graves disease
title_sort bitemporal independent 3-hz spike-and-waves in adult patient with idiopathic generalized epilepsy and graves disease
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599360/
https://www.ncbi.nlm.nih.gov/pubmed/33150271
http://dx.doi.org/10.1016/j.cnp.2020.09.001
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