F. Assal et al., SPECT in periodic lateralized epileptiform discharges (PLEDs): a form of partial status epilepticus?, SEIZURE-E J, 10(4), 2001, pp. 260-264
Periodic lateralized epileptiform discharges (PLEDs) are a well defined ele
ctroencephalographic entity but whether PLEDs represent an ictal condition
or not remains debated. Much work has been done using electroencephalograph
y (EEG) but new approaches using cerebral perfusion imaging may give more i
nformation about this question. We aimed to evaluate if PLEDs were associat
ed with high regional cerebral blood flow (rCBF).
We studied 18 patients with PLEDs and different pathologies, and performed
brain single-photon-emission computed tomography (SPECT) during and, for th
ree cases, after the disappearance of PLEDs. Qualitative variations and loc
ations of rCBF were compared with PLEDs. Association with seizures and type
of seizures were also assessed.
SPECT showed high rCBF in 18/18 patients (100%). The location of PLEDs and
high rCBF matched in 17/18 cases (94%). In the three cases where SPECT was
performed after PLEDs disappeared, the high rCBF had cleared (100%). Eighte
en cases (100%) presented seizures before recording of PLEDs, mainly motor
(partial motor or generalized tonic-clonic).
Where there was a decreased rCBF (related to a lesion) there was little rel
ationship to PLEDs and all patients with decreased rCBF had an adjacent inc
reased rCBF These results confirm preliminary case reports. Hyperperfusion
adds further to the argument that PLEDs may be related to a form of partial
status epilepticus. (C) 2001 BEA Trading Ltd.