title: A unique ictal EEG pattern in a patient with the coexistence of generalized and focal epilepsy.
abstract: The coexistence of focal and generalized epilepsy is rare. We report on a 17-year-old male with drug-resistant focal epilepsy and idiopathic generalized epilepsy (IGE). He began to experience generalized tonic-clonic seizures (GTCS) at the age of 3 years, with a good response to phenobarbital. At the age of 14 years, he began to experience complex partial seizures (CPS). Video-electroencephalography (video-EEG) telemetry showed the coexistence of right temporal spikes and bursts of generalized spike-wave (GSW). The ictal EEG showed a unique EEG pattern characterized by a 4- to 5-second burst of GSW followed by rhythmic delta activity over the right temporal region. A magnetic resonance image (MRI) showed right hippocampal sclerosis. The patient underwent a right temporal lobectomy that significantly improved his seizure control. He was rendered seizure free of the complex partial seizures and improvement of the GTCS. This case illustrates a very uncommon ictal EEG pattern, and shows that the decision for surgery in patients with focal drug-resistant epilepsy should not be affected by coexistent generalized epilepsy.
authors.affiliation: Neurology Department, Hospital Pablo Tobón Uribe, Medellin, Antioquia, Colombia.
authors.forename: Lady Diana
authors.initials: LD
authors.lastname: Ladino
authors.affiliation: Clinical Neurophysiology Laboratory, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
authors.forename: Aaron
authors.initials: A
authors.lastname: Gleadow
authors.affiliation: Division of Neurology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada jose.tellez@usask.ca.
authors.forename: José F
authors.initials: JF
authors.lastname: Téllez-Zenteno
mesh_terms: D000293:Adolescent; D003933:Diagnosis; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods*; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D004829:Epilepsy, Generalized / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D013702:Temporal Lobe / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: classification; epilepsy surgery; idiopathic generalized epilepsy; seizures; temporal lobe epilepsy