No To Hattatsu. 1991 Nov;23(6):583-9.

Clinicoencephalographic study of periodic lateralized epileptiform discharges in infants].

[Article in Japanese] Kawashima K, Hamano K, Iwasaki N, Takeya T, Horigome Y.

Source
Institute o !pecial "#ucation, $ni%ersity o Tsuku&a, I&araki.

Abstract
The mechanism o perio#ic laterali'e# epilepti orm #ischarges ()*"+s, still remains unclear, although it has &een the su&-ect o a num&er o theories. .e in%estigate# the relationship &etween the le%el consciousness an# )*"+s in or#er to clari y &oth the clinical signi icance an# the mechanism o )*"+s. .e stu#ie# two neonates an# two in ants with acute organic lesions o the &rain (cere&ral in arction, meningoencephalitis, cere&ral hemorrhage, acute in antile hemiplegia,, o whom all showing )*"+s in ""/. In each case, we analy'e# se0uential ""/ recor#s an# the le%el o consciousness, an# measure# the perio#icity, %oltage an# #uration o )*"+s &y a computer controlle# #igiti'er. In each case, the perio#icity an# %oltage o the #ischarges were relate# to the le%el o consciousness. The appearance rate o )*"+s was relati%ely high at the le%el o consciousness rom III1233 to III1433. The in%erse correlation &etween the re0uency (25perio#icity, an# the %oltage o )*"+s was signi icant in 678 o the total recor#s o )*"+s9 it was also re0uently o&ser%e# at the le%el o consciousness &etween III1233 an# III1433. :rom a&o%e in#ings we conclu#e# that an appropriate #egree o #amage to pro#uce )*"+s is re0uire# in &oth the cere&ral corte; an# su&cortical white matter correspon#ing to the le%el o consciousness rom III1233 to III1433. )<I+= 2>?3436 [)u&<e# 1 in#e;e# or <"+*IN"] 433> Jun9@(4,=2?A1@.

Chronic PLEDs with transitional rhythmic discharges PLEDs!plus" in remote stro#e.

TBlle'1Centeno J:, )illai !N, Hill <+, )illay N.

Source

+i%ision o Neurology, +epartment o <e#icine. $ni%ersity o !askatchewan, !askatoon, !askatchewan, Dana#a. - telle'Eyahoo.com

Abstract
Fackgroun#. )erio#ic laterali'e# epilepti orm #ischarges ()*"+s, are a rare phenomenon in electroencephalography, occurring in acute structural &rain lesions. In general, )*"+s appear transiently in acute lesions, &ut a ew reports ha%e #escri&e# persistent )*"+s in chronic lesions. Dase report. An G?1year1ol# emale was a#mitte#, in 2@@@, with a le t <DA stroke associate# with right han# ocal motor sei'ures. The irst ""/ in :e&ruary o 4334 showe# )*"+s o%er the le t hemisphere associate# with rhythmic #ischarges ()*"+s1plus,. The patient was a#mitte# on a secon# occasion in 4337 &ecause o three se0uential sei'ures an# the ""/ showe# a similar pattern. :inally in 433?, the patient was a#mitte# again &ecause o se0uential comple; partial sei'ures an# an ""/ showe# the same )*"+!1plus pattern as the ""/s o 4334 an# 4337. +iscussion. .e report an unusual case o chronic )*"+s associate# with rhythmic #ischarges in a patient with recurrent sei'ures an# remote stroke.
2002 Oct 16-31;35(8):734-7.

$Periodic lateralised epileptiform discharges as a form of presentation of neurosyphilis].

[Art c!" # $%a# s&' (a)ac&o-$a!as A* +art,"--$a! o A* .arc,a-+ora!"s /* 0 !!ar"1o-.a!"#2" A* 2" !a 3"4a 3.

Source
!er%icio #e NurologHa, Hospital $ni%ersitario 24 #e Ictu&re, <a#ri#, "spaJa. anitacomEmi;mail.com

Abstract
INTRODUCTION:

Neurosyphilis is a recognise# cause o epileptic sei'ures, &ut its association with perio#ic lateralise# epilepti orm #ischarges ()*"+, has &een #escri&e# only rarely, in spite o the act that it gi%es rise to acute %ascular lesions.
CLINICAL CASE:

.e report the case o a male patient who was #iagnose# as ha%ing meningo%ascular syphilis a ter the onset o tonic clonic epileptic sei'ures an# )*"+ in the le t rontotemporal region. The initial neurological e;ploration re%eale# a syn#rome o con usion an# mil# mi;e#, &ut

pre#ominantly motor, #ysphasia. In complementary tests, the most noteworthy eatures were positi%e luetic serology in the &loo# an# in cere&rospinal lui# (D!:,, which was con irme# &y means o treponemic assays. The patient was treate# with penicillin or two weeks. The stu#y was complete# with a magnetic resonance (<K, &rain scan that showe# a small le t temporal in arction, which was the origin o the clinical an# electrical con%ulsi%e acti%ity. The patient s e%olution was satis actory, with an impro%ement in the language #isor#er, an# the sei'ures were controlle# a ter the a#ministration o phenytoin. The control electroencephalogram (""/, that was per orme# later only showe# a slowing in the known in-ure# area.
CONCLUSIONS:

)*"+ are an in re0uent electroencephalographic pattern whose appearance has &een linke# with acute &rain lesions, mainly with strokes, tumours an# meningoencephalitis. .hen, e;ceptionally, they appear as a conse0uence o an ischemia secon#ary to meningo%ascular syphilis their signi icance, clinical eatures an# prognosis #o not #i er rom other causes o a cere&ro%ascular #isease. 2@@? No%927(?,=62@173.

Periodic lateralized epileptiform discharges!!a critical re%iew.

)ohlmann1"#en F, Hoch +F, Dochius JI, Dhiappa KH.

Source
+epartment o Neurology, <annheim Hospital, $ni%ersity o Hei#el&erg, /ermany.

Abstract
It is the purpose o this re%iew to critically consi#er an# organi'e the literature #ealing with the ephemeral electroencephalographic (""/, pattern perio#ic laterali'e# epilepti orm #ischarges ()*"+s,. Although the retrospecti%e nature o these stu#ies limits their a&ility to #iscuss accurately the clinical an# pathophysiological aspects o this ""/ entity, the a%aila&le #ata strongly emphasi'e stroke as the #ominant etiology an# its high association with sei'ures. Kecent e%i#ence, particularly rom unctional neuroimaging stu#ies, strongly suggests that )*"+s might re lect a key pattern or ocal hypere;cita&ility in the penum&ra 'one o ischemic stroke. The authors pre er to consi#er )*"+s as an ""/ signature o a #ynamic pathophysiological state in which unsta&le neuro&iological processes create an ictal1 interictal continuum, with the nature o the un#erlying neuronal in-ury, the patientLs pree;isting propensity to ha%e sei'ures, an# the co1e;istence o any acute meta&olic #erangements all contri&uting to whether sei'ures occur or not. This re%iew un#erlines the nee# or urther sophisticate# prospecti%e controlle# stu#ies implementing early continuous ""/ monitoring in or#er to contri&ute to an un#erstan#ing o the inci#ence, #ynamics, an# rele%ance o this pattern.

2@G? Jan92>(2,=7?1A7.

Periodic lateralized epileptiform discharges PLEDs"& a possible role for metabolic factors in pathogenesis.
Janati A, Dhesser <C, Husain <<.

Abstract
)erio#ic, laterali'e#, epilepti orm #ischarges ()*"+s, in the electroencephalogram ha%e &een reporte# in association with a %ariety o structural lesions o the &rain. Although a great #eal o attention has &een #irecte# to the neuropathological &asis o )*"+s, little emphasis has &een place# on the unctional &asis o this ""/ syn#rome. In this paper, we reporte# a patient with multiple systemic pro&lems whose ""/ showe# )*"+s. Howe%er, ra#iological an# pathological stu#ies re%eale# no neuropathological &asis or the occurrence o this ""/ syn#rome. Thus, we presente# e%i#ence that meta&olic actors may play a part in the pathogenesis o )*"+s 433A Apr976(4,=GG1@7.

Structural lesions in periodic lateralized epileptiform discharges PLEDs".

/urer /, Yemisci <, !aygi !, Diger A.

Source
Neurology +epartment, Hacettepe $ni%ersity, :aculty o <e#icine, Ankara, Turkey.

Abstract
In this stu#y we in%estigate# the structural lesions o patients with perio#ic laterali'e# epilepti orm #ischarges ()*"+s, to #etermine the possi&le relationship o lesions to )*"+sL locali'ation on ""/ an# to meta&olic a&normality. Dlinical in#ings an# electroencephalography (""/,, computeri'e# tomography (DT, an# magnetic resonance imaging (<KI, o the >2 a#ult patients with )*"+s were e%aluate#. !troke, herpes encephalitis an# intracranial tumor or a&scess were the most common etiological actors. Dortical gray matter an# a#-acent su&cortical white matter lesions were #etecte# in ?A.>8, cortical gray matter lesions in 22.78 an# su&cortical white matter lesions in A.48 o the patients. Although it is thought that )*"+s occur mostly with acute lesions, chronic lesions causing )*"+s were oun# in 76.48 o the patients. Filateral lesions were #etecte# in 2@.>8 an# 77.G8 o the patients ha# meta&olic a&normality. )*"+s locali'e# the region o the lesion in ?7.A8 o the patients. )*"+s are usually sel 1limite# eatures, &ut chronic )*"+s

were #etecte# in 6 patients in this stu#y. Acute structural lesions in%ol%ing cortical gray matter with a#-acent su&cortical white matter were oun# in most o the patients with )*"+s, &ut the lesion locali'ation an# age, acute or chronic, %arie#.

2@@7 <ar1Apr97A(4,=4>@1G7.

Defining the role of structural lesions and metabolic abnormalities in periodic lateralized epileptiform discharges.
Karo0ue H/ Jr, /on'ales )D, Jha%eri H!, *eroy K:, Allen "D.

Source
+epartment o Neurology, $ni%ersity o Te;as !outhwestern <e#ical Denter, +allas >64761 GG@>.

Abstract
.e re%iewe# the ""/, clinical mani estations, compute# tomography (DT, an# magnetic resonance imaging (<KI, scans o 7@ patients with perio#ic laterali'e# epilepti orm #ischarges ()*"+s, or &ilateral perio#ic laterali'e# epilepti orm #ischarges (FI)*"+s, to #etermine the role o structural lesions (!*, an# meta&olic a&normalities (<A, in their pathogenesis. Thirty1eight patients ha# DT an# > ha# <KI scans. Thirty1eight ha# lesions on DT or <KI. All those with )*"+s consistently ha# lesions on the si#e o the #ischarges, an# 6 o ? with FI)*"+s ha# lesions on &oth hemispheres. A su&group o 47 patients with meta&olic #etermination within 4A h o ""/ all showe# mil# to mo#erate <A. They all also ha# !*. These in#ings support a primary role or !* &ut cannot e;clu#e an a##itional role or <A.
2007 5u!;48(7):1396-405. 6%u7 2007 +ar 26.

'euroimaging and neurophysiology of periodic lateralized epileptiform discharges& obser%ations and hypotheses.
8a!a)a#9a!a) .3* : "&! ;* ;ur9"ss <(.

Source
!ection o "pilepsy, +epartment o Neurology, Dle%elan# Dlinic, Dle%elan#, Ihio, $!A. /iri#har.).KalamangalamEuth.tmc.e#u

Abstract
PURPOSE:

.e assesse# neuroimaging lesion type an# #istri&ution in patients with perio#ic laterali'e# epilepti orm #ischarges ()*"+s,, with a %iew to i#enti ying electrographic #i erences &etween )*"+s associate# with #i ering lesion locations. Iur o&ser%ations le# us to consi#er a conceptual synthesis &etween )*"+s an# perio#ic comple;es ()Ds,.
METHODS:

Ketrospecti%e re%iew o acute neuroimaging results (DT5<KI, on patients i#enti ie# to ha%e ""/ )*"+s, or the perio# 2@@@14337 (nM23?,. Flin#e# classi ication o original ""/ recor#ings.
RESULTS:

Neuroimaging a&normalities were classi ie# as acute or chronic cortical, or acute or chronic su&cortical. !e%en out o 23? scans were classi ie# nonlesional. I%erall appro;imately >38 o scans ha# cortical a&normalities, whether acute or chronic9 appro;imately 478 ha# su&cortical a&normalities. NDorticalN )*"+s were signi icantly longer in #uration (pO3.36, an# more %aria&le in morphology (pO3.32, than Nsu&corticalN )*"+s.
CONCLUSIONS:

!tructural &rain #isease commonly, &ut not in%aria&ly, un#erlies )*"+s9 lesion type is spatiotemporally %aria&le. Dortical an# su&cortical )*"+s ha%e #istinct ""/ signatures. There is e%i#ence that these may relate to mechanisms or other pathological large1scale oscillatory &rain synchronies (e.g., )Ds,.

Periodic EE( patterns& classification) clinical correlation) and pathophysiology.

Frenner K), !chaul N.

Source
+epartment o )sychiatry, $ni%ersity o )itts&urgh, )ennsyl%ania.

Abstract
In this article, we re%iew perio#ic ""/ patterns, which ha%e &een classi ie# into our #i erent types &ase# on their inter%al #uration (short or long, an# topographic #istri&ution (laterali'e#, &ilaterally in#epen#ent, or #i use an# synchronous,. The our patterns are= (2, perio#ic laterali'e# epilepti orm #ischarges9 (4, &ilateral in#epen#ent perio#ic laterali'e# epilepti orm #ischarges9 (7, perio#ic short1inter%al #i use #ischarges9 an# (A, perio#ic long1

inter%al #i use #ischarges. .e also #iscuss morphology, etiologies, an# clinical correlates o each pattern an# possi&le pathophysiological mechanisms o perio#icity.