Peri-ictal headache due to epileptiform activity in a disconnected hemisphere.
A 4-year-old girl with intractable epilepsy due to left-side hemispheric cortical dysplasia underwent a hemispherotomy. She was seizure-free after the surgery. EEG showed persistent abundant epileptiform activity over the left (disconnected) hemisphere, including ictal patterns that neither generalised nor had clinical correlates. Antiepileptic medication was completely withdrawn four years following the surgery. One week after the withdrawal, she developed episodes of intense left-sided hemicranias (ipsilateral to the surgery) with vomiting and photophobia that did not resemble her habitual seizures and were unresponsive to non-steroidal anti-inflammatory drugs. Video-EEG showed association of the headache attacks with ictal patterns over the disconnected hemisphere. Brain MRI revealed increased signal changes in the left hemisphere. Attacks responded promptly to i.v. midazolam and carbamazepine at a low dose. Mechanisms underlying peri-ictal headache originating in the disconnected hemisphere are discussed. [Published with video sequences].
Department of Pediatric Neurology.
Rosa
R
Vydrova
Department of Pediatric Neurology.
Pavel
P
Kršek
Department of Radiology.
Martin
M
Kyncl
Department of Pediatric Neurology.
Alena
A
Jahodova
Department of Neurosurgery, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
Josef
J
Dvorak
Department of Pediatric Neurology.
Vladimir
V
Komarek
Fondation Ophtalmologique Adolphe de Rothschild, Neurochirurgie Pédiatrique, Paris, France.
Olivier
O
Delalande
Department of Neurosurgery, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
Michal
M
Tichy
D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002220:Carbamazepine / Q000627:therapeutic use; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D007839:Functional Laterality; D006261:Headache / Q000150:complications* / Q000473:pathology; D038421:Hemispherectomy; D006801:Humans; D008874:Midazolam / Q000627:therapeutic use; D019635:Neurosurgical Procedures; D012640:Seizures / Q000150:complications* / Q000473:pathology
D000927:Anticonvulsants; D002220:Carbamazepine; D008874:Midazolam
AED withdrawal; hemispherotomy; peri-ictal headache