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A multimodal diagnostic approach for lateralised rhythmic delta activity in the ictal‐interictal continuum ∗
Author(s) -
Spalletti Maddalena,
Pescini Francesca,
Gadda Davide,
Piccardi Benedetta,
Scarpino Maenia,
Carrai Riccardo,
Boccardi Cristina,
Grippo Antonello,
Amantini Aldo
Publication year - 2020
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.2020.1169
Subject(s) - ictal , electroencephalography , neuroscience , psychology , medicine , audiology
The ictal‐interictal continuum represents a diagnostic challenge even for expert neurrophysiologists, often requiring an additional multimodal diagnostic workup to understand its clinical significance. Lateralised rhythmic delta activity (LRDA) is an ictal‐interictal continuum pattern that has only recently been investigated and recognised as potentially ictogenic or sometimes even ictal. We describe a patient who presented with acute‐onset aphasia, initially suspected of having a stroke; advanced brain imaging with CT‐perfusion showed features suggesting regional left temporo‐parietal hyperperfusion and an EEG revealed LRDA with fluctuations and intermixed sharp waves in the same areas. Treatment with lacosamide caused both clinical and EEG improvement after a few hours, supporting the hypothesis that the EEG pattern represented an ictal/interictal phenomenon. In the literature, a correlation between metabolic/perfusion imaging and ictal‐interictal continuum patterns is described regarding lateralised periodic discharges but less studied for LRDA. In this case, we adopted a multimodal approach, integrating advanced imaging, EEG, clinical features, and response to therapy, to consider the overall clinical presentation as focal NCSE.

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