Acquired epileptiform opercular syndrome evaluated with real-time transcranial Doppler ultrasound-video-electroencephalogram before and after treatment: a case report

Bing-Wei Peng,Si-Yuan Yang,Wen-Xiong Chen,Wei Liang,Hui-Ci Liang,Jia-Ling Li,Feng-Qiong Zhang

doi:10.1186/s12883-019-1389-0

Bing-Wei Peng, Si-Yuan Yang + Show 5 more

Open Access

https://doi.org/10.1186/s12883-019-1389-0

Copy DOI

Journal: BMC Neurology	Publication Date: Jul 17, 2019
Citations: 4	License type: open-access

Affiliation: Guangzhou Medical University

Abstract

BackgroundAcquired epileptiform opercular syndrome (AEOS) with electrical status epilepticus during sleep (ESES) may be recurrent and intractable. The real-time transcranial Doppler ultrasound–sleep-deprived video electroencephalogram (TCD-SDvEEG) can be used to observe the relationships among hemodynamic, electrophysiological, and clinical factors in a patient during therapy. This study reported the case of a healthy 5-year-old boy with AEOS.Case presentationThe patient had initial seizures during sleep at the age of 1 year, with the left mouth pouting, left eye blinking and drooling for several seconds, and, sometimes, the left upper-limb flexion and head version to the left, lasting for 1–2 min. The combined antiepileptic drug regimens, including valproate, lamotrigine, and clonazepam, failed in the present case. Therefore, the add-on high-dose methylprednisolone therapy was provided. Also, the serial TCD-SDvEEG was used to monitor the dynamic changes before and after add-on steroid treatment. The results showed less than 15% variation in the range of blood flow fluctuation with spikes during non-rapid eye movement sleep after treatment. This was similar to the outcomes in healthy children and also accorded with the clinical improvements such as seizure control, drooling control, and language ability melioration. However, 95% of spike-wave index (SWI) was still maintained. The improvements in cerebral hemodynamics and clinical manifestations were faster and earlier than the SWI progression.ConclusionsThe real-time TCD-SDvEEG was highly sensitive in detecting therapeutic changes. The findings might facilitate the understanding of the mechanisms underlying neurovascular coupling in patients with AEOS accompanied by ESES.

Highlights

The real-time transcranial Doppler ultrasound (TCD)-SDvEEG was highly sensitive in detecting therapeutic changes
The findings might facilitate the understanding of the mechanisms underlying neurovascular coupling in patients with Acquired epileptiform opercular syndrome (AEOS) accompanied by Electrical status epilepticus during sleep (ESES)
The acquired epileptiform opercular syndrome (AEOS) is a rare epileptic syndrome, which manifests with typically focal motor seizures, involving the face, and occasionally rolandic seizures, accompanied by severe oral motor dysfunction, drooling, dysarthria, speech arrest, or linguistic problems involving phonologic productions [1]

Summary

Conclusions

The real-time TCD-SDvEEG was highly sensitive in detecting therapeutic changes. The findings might facilitate the understanding of the mechanisms underlying neurovascular coupling in patients with AEOS accompanied by ESES.

Introduction

Findings

Discussion and conclusions