Peri-ictal headache due to epileptiform activity in a disconnected hemisphere
Language English Country United States Media print
Document type Case Reports, Journal Article, Research Support, Non-U.S. Gov't
PubMed
24777063
DOI
10.1684/epd.2014.0653
PII: epd.2014.0653
Knihovny.cz E-resources
- Keywords
- AED withdrawal, hemispherotomy, peri-ictal headache,
- MeSH
- Anticonvulsants therapeutic use MeSH
- Headache complications pathology MeSH
- Electroencephalography MeSH
- Epilepsy complications pathology surgery MeSH
- Functional Laterality MeSH
- Hemispherectomy MeSH
- Carbamazepine therapeutic use MeSH
- Humans MeSH
- Midazolam therapeutic use MeSH
- Brain pathology MeSH
- Neurosurgical Procedures MeSH
- Child, Preschool MeSH
- Seizures complications pathology MeSH
- Check Tag
- Humans MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Anticonvulsants MeSH
- Carbamazepine MeSH
- Midazolam MeSH
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 Antiepileptic medication was completely withdrawn four years following the surgery.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
Fondation Ophtalmologique Adolphe de Rothschild Neurochirurgie Pédiatrique Paris France
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