Broutian Amayak, Dolgova Snezhana, Belyakova-Bodina Alexandra, Abramova Anna, Lukianova Anastasia, Noskova Tatiana
Research Center of Neurology, Moscow, Russian Federation.
Clin Neurophysiol Pract. 2020 Oct 14;5:206-208. doi: 10.1016/j.cnp.2020.09.001. eCollection 2020.
We present a case of idiopathic generalized epilepsy (IGE) with seizures manifesting in the context of Graves disease and unusual interictal EEG pattern of bilateral independent 3 Hz spike and wave activity.
A 33-year old man with three generalized tonic-clonic seizures (GTCS) in history admitted for overnight video-EEG. At the age of 28, he had his first seizure soon after being diagnosed with Graves' disease. For four years, he received thiamazole and then underwent total thyroidectomy. EEG showed a high number of generalized 3-Hz spike-and-wave discharges (GSWD) but also revealed numerous runs of bitemporal independent lateralized 3-Hz spike-and-wave activity (LSWA). GSWD and LSWA were mostly independent and had slightly different morphology. A diagnosis of IGE with GTCS upon awakening was made. On levetiracetam therapy, the patient demonstrated no seizure recurrence during 2-year follow-up. Repeated overnight EEG showed significant GSWD reduction and complete LSWA suppression.
To our knowledge, in patients with IGE, strictly lateralized spike-and-wave activity was never reported. In this case, thyroid dysfunction seemed to increase propensity to generate spontaneous seizures. We speculate that thyroid dysfunction superimposed on IGE thalamocortical network oscillations resulted in uncommon bitemporal independent LSWA.
我们报告一例特发性全身性癫痫（IGE）病例，其癫痫发作在格雷夫斯病背景下出现，且发作间期脑电图呈现不寻常的双侧独立3Hz棘波和慢波活动模式。
一名33岁男性，有三次全身性强直阵挛发作（GTCS）病史，因进行夜间视频脑电图检查入院。28岁时，他在被诊断为格雷夫斯病后不久首次发作。四年间，他接受了甲巯咪唑治疗，随后接受了甲状腺全切术。脑电图显示大量全身性3Hz棘慢波放电（GSWD），但也发现多次双侧颞叶独立的3Hz棘慢波活动（LSWA）。GSWD和LSWA大多相互独立，且形态略有不同。诊断为觉醒期IGE伴GTCS。在左乙拉西坦治疗期间，患者在2年随访中未出现癫痫复发。重复夜间脑电图显示GSWD显著减少，LSWA完全抑制。
据我们所知，在IGE患者中，从未有过严格单侧化的棘慢波活动的报道。在该病例中，甲状腺功能障碍似乎增加了产生自发性癫痫发作的倾向。我们推测，叠加在IGE丘脑皮质网络振荡上的甲状腺功能障碍导致了不常见的双侧颞叶独立LSWA。
