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PLEDS : corrélations cliniques

Published online by Cambridge University Press:  02 December 2014

W. Fitzpatrick  and
N. Lowry
W. Fitzpatrick
Affiliation:
Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
N. Lowry
Affiliation:
Department of Pediatric Neurology, University of Saskatchewan, Saskatoon, SK, Canada
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Abstract

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Objective:

We reviewed our experience in 96 consecutive patients exhibiting periodic lateralized epileptiform discharges (PLEDs) on EEG.

Methods:

EEG reports from January 1, 1999 to September 30, 2006 were screened for the term ‘PLEDs’ and its variants. A retrospective chart review, including examination of neuroimaging and other investigations, was conducted on each patient identified.

Results:

Acute stroke, tumor and central nervous system infection were the most common etiologies, accounting for 26%, 12% and 12% of cases respectively. Acute hemorrhage and traumatic brain injury combined accounted for another 12%. Previously unreported etiologies included posterior reversible encephalopathy syndrome (PRES), familial hemiplegic migraine and cerebral amyloidosis. There were 9 cases of chronic PLEDs attributable to underlying cortical dysplasia or severe remote cerebral injury, all with an accompanying partial seizure disorder. A prominent role for alcohol withdrawal was noted, and in 6 cases was the sole etiological factor. Fever was present as a potential contributing factor in 40% of cases, and significant metabolic abnormalities in 35%. Seizure activity occurred in 85% of patients overall, but in 100% of patients with PLEDs Plus and BiPLEDs Plus. The overall mortality rate was 27%. Mortality among patients with BiPLEDs however was almost twice that, at 52%.

Conclusions:

This case series demonstrates the wide variety of potential PLED etiologies. It also emphasizes that despite advances in neurocritical care, the morbidity and mortality associated with PLEDs has changed little since their recognition four decades ago.

Résumé:

RÉSUMÉ: <span class='italic'> <span class='bold'>Objectif</span></span>:

Nous avons revu notre expérience concernant 96 patients consécutifs présentant des décharges épileptiformes latéralisées périodiques (PLEDs) à l'ÉEG.

<span class='italic'> <span class='bold'>Méthodes</span></span>:

Nous avons vérifié si le terme « PLEDs » ou ses variantes figurait dans les rapports d'ÉEG émis entre le 1er janvier 1999 et le 30 septembre 2006. Nous avons révisé rétrospectivement les dossiers de tous les patients identifiés et nous avons examiné la neuroimagerie ainsi que les autres examens effectués.

<span class='italic'> <span class='bold'>Résultats</span></span>:

Les étiologies les plus communes étaient un accident vasculaire cérébral aigu, une tumeur et une infection du système nerveux central, chez 26%, 12% et 12% des cas respectivement. Un autre 12% était dŭ soit à une hémorragie aigue ou à un traumatisme crànien. D'autres étiologies, soit le syndrome de leucoencéphalopathie réversible postérieur, la migraine hémiplégique familiale et l'amyloi'dose cérébrale n'ont jamais été rapportées antérieurement. Il y avait 9 cas de PLEDs chroniques attribuables à une dysplasie corticale sous-jacente ou à un traumatisme cérébral ancien sévère et tous ces patients présentaient une épilepsie partielle. On a remarqué que le sevrage alcoolique jouait un role important et que c'était le seul facteur étiologique chez 6 patients. La présence d'une hyperthermie était un facteur qui avait pu contribuer chez 40% des patients et des anomalies métaboliques significatives chez 35%. On a observé une activité épileptique chez 85% de tous les patients et chez 100% de ceux chez qui on a observé des PLEDs Plus et des BiPLEDs Plus. Le taux de mortalité global était de 27%. Cependant le taux de mortalité des patients ayant des BiPLEDs était presque le double, soit 52%.

<span class='italic'> <span class='bold'>Conclusions</span></span>:

Cette étude démontre la grande variété d'étiologies des PLEDs. De plus, malgré les progrès réalisés dans le domaine des soins neurocritiques, la morbidité et la mortalité associées aux PLEDs ont peu changé depuis leur identification il y a une quarantaine d'années.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 4 , November 2007 , pp. 443 - 450
Copyright
Copyright © The Canadian Journal of Neurological 2007

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