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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 52, Num. 4, 2004, pp. 523-524

Neurology India, Vol. 52, No. 4, October-December, 2004, pp. 523-524

Letter To Editor

Periodic lateralized epileptiform discharges (PLEDs) in a child with solitary cysticercus granuloma

Department of Neurological Sciences, Christian Medical College Hospital, Vellore - 632 004
Correspondence Address:Department of Neurological Sciences, Christian Medical College Hospital, Vellore - 632 004,

Code Number: ni04186


Periodic lateralized epileptiform discharges (PLEDs) are a well-defined electroencephalographic entity known for the past four decades. PLEDs have been associated with both partial and generalized seizures, and typically with status epilepticus (SE).[1] PLEDs were found in only 0.5% of 8002 pediatric electroencephalographic (EEG) studies.[2] PLEDs have been described in association with a variety of conditions including cerebrovascular accidents, viral encephalitis, subdural hematoma, metabolic abnormalities, mitochondrial encephalomyopathy, diffuse neurocysticercosis,[3] neurosyphilis and acquired immunodeficiency syndrome. Approximately two-thirds of pediatric cases are related to central nervous system infections.[2]

A ten-year-old child, the youngest of nine siblings, was brought with a five-hour history of repeated right focal motor seizures. He had twitching of tongue and right hand associated with tonic deviation of head to the right side. Initial episodes were secondarily generalized, but after admission, he continued to have right focal motor seizures without loss of consciousness. A clinical diagnosis of status epilepticus was made. He was treated with intravenous lorazepam and phenytoin loading dose with which his seizures were controlled.

Contrast brain CT scan [Figure - 1] showed features suggestive of a solitary cysticercus granuloma (SCG) in the left medial frontal lobe. Electroencephalogram (EEG) done the following day [Figure - 2] showed persistent periodic bursts of biphasic sharp-wave discharges up to 500 mv in amplitude, periodic lateralized epileptiform discharges (PLEDs) over the left hemisphere with predominance to the central and parietal regions, occurring at a frequency of one per second. Serum anticysticercal antibody was positive.

EEG repeated after ten days had normalized. The child has been seizure-free during 15 months of follow-up and a repeat CT scan seven months after the initial presentation showed complete resolution of the granuloma.

SE can rarely be the presenting feature of SCG.[4] Patients with diffuse neurocysticercosis have shown EEG changes suggestive of PLEDs.[3] PLEDs are thought to be ictal phenomena and this hypothesis has been strengthened by demonstrating increased cerebral blood flow in the region of origin of PLEDs, with the help of SPECT studies.[5] PLEDs occur in the later stages of SE.[1] Others believe that PLEDs may be considered as a manifestation of an increased neuronal excitability caused by different etiologies but not an ictal pattern.[6] PLEDs are thought to indicate an adverse clinical outcome. In an earlier study, about half the children with PLEDs died and the majority of survivors developed epilepsy.[7] In a recent study, out of 13 children with PLEDs, two died and six had neurological sequelae.[8] However, in the current report, the child had an excellent outcome. The good outcome in this child suggests that the prognosis in patients with PLEDs is determined by the underlying cause. If the etiology is a benign condition like SCG, the outcome may be excellent.

1.Treiman DM, Walton NY, Kendrick C. A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res 1990;5:49-60.  Back to cited text no. 1  [PUBMED]  
2.Chen KS, Kuo MF, Wang HS, Huang SC. Periodic lateralized epileptiform discharges of pediatric patients in Taiwan. Pediatr Neurol 2003;28:100-3.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Virmani V, Roy S, Kamala G. Periodic lateralised epileptiform discharges in a case of diffuse cerebral cysticercosis. Neuropadiatrie 1977;8:196-203.  Back to cited text no. 3  [PUBMED]  
4.Rajshekhar V. Incidence and significance of adverse effects of albendazole therapy in patients with a persistent solitary cysticercus granuloma. Acta Neurol Scand 1998;98:121-3.  Back to cited text no. 4  [PUBMED]  
5.Assal F, Papazyan JP, Slosman DO, Jallon P, Goerres GW. SPECT in periodic lateralized epileptiform discharges (PLEDs): A form of partial status epilepticus? Seizure 2001;10:260-5.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Baykan B, Kinay D, Gokyigit A, Gurses C. Periodic lateralized epileptiform discharges: Association with seizures. Seizure 2000;9:402-6.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Garg BP, Patel H, Markand ON. Clinical correlation of periodic lateralized epileptiform discharges in children. Pediatr Neurol 1995;12:225-9.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Yoshikawa H, Abe T. Periodic lateralized epileptiform discharges in children. J Child Neurol 2003;18:803-5.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]

Copyright 2004 - Neurology India

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