title: Epileptogenic developmental venous anomaly: insights from simultaneous EEG/fMRI.
abstract: Developmental venous anomalies (DVAs) are associated with epileptic seizures; however, the role of DVA in the epileptogenesis is still not established. Simultaneous interictal electroencephalogram/functional magnetic resonance imaging (EEG/fMRI) recordings provide supplementary information to electroclinical data about the epileptic generators, and thus aid in the differentiation of clinically equivocal epilepsy syndromes. The main objective of our study was to characterize the epileptic network in a patient with DVA and epilepsy by simultaneous EEG/fMRI recordings. A 17-year-old woman with recently emerging generalized tonic-clonic seizures, and atypical generalized discharges, was investigated using simultaneous EEG/fMRI at the university hospital. Previous high-resolution MRI showed no structural abnormalities, except a DVA in the right frontal operculum. Interictal EEG recordings showed atypical generalized discharges, corresponding to positive focal blood oxygen level dependent (BOLD) correlates in the right frontal operculum, a region drained by the DVA. Additionally, widespread cortical bilateral negative BOLD correlates in the frontal and parietal lobes were delineated, resembling a generalized epileptic network. The EEG/fMRI recordings support a right frontal lobe epilepsy, originating in the vicinity of the DVA, propagating rapidly to both frontal and parietal lobes, as expressed on the scalp EEG by secondary bilateral synchrony. The DVA may be causative of focal epilepsies in cases where no concomitant epileptogenic lesions can be detected. Advanced imaging techniques, such as simultaneous EEG/fMRI, may thus aid in the differentiation of clinically equivocal epilepsy syndromes.
authors: Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors: Olivier
authors: O
authors: Scheidegger
authors: Roland
authors: R
authors: Wiest
authors: Kay
authors: K
authors: Jann
authors: Thomas
authors: T
authors: König
authors: Klaus
authors: K
authors: Meyer
authors: Martinus
authors: M
authors: Hauf
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002550:Cerebral Veins / Q000002:abnormalities*; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging
chemical_list: D000927:Anticonvulsants
keywords: DVA; EEG; EEG/fMRI; developmental venous anomaly; epilepsy