title: Adversive seizures associated with periodic lateralised epileptiform discharges (PLEDs) after left orbital contusion.
abstract: We report a patient who presented with adversive seizures associated with periodic lateralised epileptiform discharges (PLEDs), a month after head trauma. The PLEDs predominantly involving the left frontal contacts became more frequent at the onset of adversive seizures during EEG. Brain MRI demonstrated a contusion scar in the left orbital cortex with reduced diffusion, not only around this orbital lesion but also in the ipsilateral anteromedial thalamus. Single photon emission computed tomography revealed focal cerebral hyperperfusion in the left medial orbitofrontal region, basal ganglia, and thalamus. The abnormal metabolism involving the thalamus and striatum could be associated with the ipsilateral orbital contusion and might have been caused by cortical-subcortical, trans-synaptic hyperactivity. Further studies are warranted to determine the role of subcortical structures in the generation of PLEDs and adversive seizures. [Published with video sequences].
authors.affiliation: Department of Neurology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan. ttakeda@nij.twmu.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Takeda
authors.forename: Mikio
authors.initials: M
authors.lastname: Osawa
authors.forename: Sono
authors.initials: S
authors.lastname: Toi
authors.forename: Satoko
authors.initials: S
authors.lastname: Mizuno
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uchiyama
mesh_terms: D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D004834:Epilepsy, Post-Traumatic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D013788:Thalamus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon