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Peri‐ictal headache due to epileptiform activity in a disconnected hemisphere
Author(s) -
Vydrova Rosa,
Kršek Pavel,
Kyncl Martin,
Jahodova Alena,
Dvorak Josef,
Komarek Vladimir,
Delalande Olivier,
Tichy Michal
Publication year - 2014
Publication title -
epileptic disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.673
H-Index - 53
eISSN - 1950-6945
pISSN - 1294-9361
DOI - 10.1684/epd.2014.0653
Subject(s) - ictal , anesthesia , electroencephalography , carbamazepine , psychology , cortical dysplasia , medicine , lateralization of brain function , epilepsy , photophobia , neuroscience
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 Antiepileptic medication was completely withdrawn four years following the surgery.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 ]