Abstracts

Rationale: To search the literature for the electroencephalogram manifestation, prognosis, and treatment of seizures and epilepsy in patients with different cerebral lesions.


Methods: We report three patient with different cerebral lesions who presented with generalized 3 Hz Spike-Waves and review the literature.


Results: Case 1: The patient diagnosed with multiple sclerosis (MS) at the age of 8, her brain magnetic resonance showed bilateral frontal lobe demyelination. 2 months later, the patient presented general tonic-clonic seizure (GTCS). Interictal electroencephalograph (EEG) showed bilateral symmetric 3-4Hz spike waves (SW) with no focal discharge, and cannot be induced by hyperventilation. Levetiracetam was given to prevent seizures. At her 9 years, several episodes of staring blankly with confuse occurred. Oral levetiracetam remained effective. We captured her ictal EEG after she had a fever, which revealed frontal onset without MS relapse.

Case 2: A male patient sustained a head trauma at the age of 3, and subsequently developed seizures at 4 years old, presenting as GTCS. Oral administration of Benztropine for seizure control proved ineffective, leading to a switch to Carbamazepine which resulted in symptom improvement. The patient discontinued anti-epileptic medication at the age of 11 but experienced a recurrence of seizures at 18 years old, prompting the resumption of Carbamazepine treatment. Seizure frequency increased to 3-4 times per year and later escalated to once monthly by the age of 23 despite adjunctive oral Valproic acid therapy. Following admission, a head MRI revealed malacia in the right orbitofrontal gyrus. Interictal EEG demonstrated SW with prominence in the right frontal and temporal regions. The hyperventilation yielded negative results. Surgical resection of the right frontal malacia led to a significant reduction in seizures. Postoperatively, therapy with sodium valproate was initiated resulting in an Engel classification II three years post-surgery; he was seizure free after reintroduction of Carbamazepine with an Engel classification I.

Case 3: The female patient, aged 6, experienced an abrupt fall with subsequent left-sided weakness and myoclonus in her left lower limb, without loss of consciousness. She received a diagnosis of epilepsy and was prescribed oxcarbazepine for treatment. But she presented with myoclonus localized to the left side manifested during meal times and recurred multiple times daily. At the age of 8, she sought further evaluation at our hospital where an EEG revealed generalized SW. Her medication was switched to levetiracetam. Initially there was a reduction in seizure frequency; however, this trend reversed over time with increased occurrences following emotional arousal or fatigue. A head CT scan identified gyriform cortical calcifications along the right parietal lobe which was subsequently surgically excised resulting in decreased seizure activity postoperatively.


Conclusions: There may be clinical heterogeneity in the EEG pattern of generalized SW, and attention should be paid to whether there is a focal origin.The frontal and parietal lobe may be involved in the process of 3HZ SW formation

Funding: No funding.