Periventricular leukomalacia and epilepsy - Incidence and seizure pattern

Objective: To study the incidence and pattern of epilepsy in patients with periventricular leukomalacia (PVLM) in two specialty clinic settings. Backg round: Motor and cognitive deficit as well as epilepsy are common in patien ts with PVLM. With modern imaging techniques, PVLM is now easily recognized . Methods: Epileptic seizures and syndromes as well as motor and cognitive deficits were correlated with MRI findings. Two patient populations were st udied: Group A-children with cerebral palsy and PVLM presenting to a center for children with motor disability (n = 19); and Group B-epileptic patient s with PVLM presenting to a tertiary epilepsy center (n = 12). A single pat ient with PVLM and epilepsy who underwent extensive investigations, includi ng intracranial EEG telemetry, is reported. Results: In Group A, 47% of pat ients had epilepsy (9/19). PVLM was found in 1.27% of patients investigated for epilepsy at a tertiary epilepsy center (12/942). The majority of patie nts in both groups had multiple seizure types, with complex partial seizure s being most common. Of patients with seizures (Groups A and B), 85.7% had intractable epilepsy (18/21). Intracranial EEG in the illustrative case dem onstrated a multifocal epileptic process with occipitotemporal predominance . Conclusions: PVLM was an uncommon underlying cause in patients presenting with epilepsy (Group A); however, patients presenting with motor disabilit y and PVLM (Group B) had a high incidence of seizures. PVLM in epileptic pa tients is associated with multiple seizure types and medically refractory d isease.