Thalamic lesion and epilepsy with generalized seizures, ESES and spike-wave paroxysms—Report of three cases

Abstract

We report three patients, who have thalamic lesion and secondary generalized epilepsy with generalized spike wave pattern. The first two patients have unilateral perinatal lesion, one with generalized tonic-clonic seizures on awakening the other with Landau-Kleffner-like syndrome. During the course of the disease both children developed electrical status epilepticus in slow wave sleep (ESES). The third patient has a dominantly unilateral thalamic tumor and epilepsy that mimics juvenile myoclonic epilepsy. All the patients have a lesion located in the inferior-medial-posterior part of the thalamus. The role of some thalamic and subthalamic nuclei in the generalized spike-wave electrical pattern patophysiology is discussed, with emphasis on the possible role of the inhibitory system from the zona incerta.

Pericallosal lipomas: aetiology of symptomatic epilepsy or incidental thalamic involvement with idiopathic generalized epilepsy?: Two case reports.

“…Only four adult patients with intractable idiopathic generalized epilepsy (IGE) were reported due to unilateral thalamic lesions with generalized SWDs on EEG have been reported. [4] It is known that the thalamus plays a crucial role in the formation of sleep spindles and generalized 3-Hz SWDs. [5] The thalamic reticular nucleus is mostly responsible for forming SWDs and sleep spindles by reciprocal excitatory and inhibitory activities between thalamocortical and nRT neurons.…”

“…[1,3] Thalamus, especially the thalamic reticular nucleus (nRT), was frequently responsible for the formation of generalized spike-wave discharges (SWDs). [4] Involvement of the posterior inferior part of the thalamus is responsible for the generation of SWDs, instead of the medial anterior region, including thalamocortical cells and surrounding reticular nucleus.…”

Encephalopathy with Electrical Status Epilepticus in Slow Wave Sleep – a review with an emphasis on regional (perisylvian) aspects

“…Patients with shunted hydrocephalus, represented approximately 30% of cases of reported by Veggiotti et al (1999) and by Caraballo et al (2008). Early thalamic lesions seemed to be also strongly associated with sleep-enhanced epileptiform discharges (Monteiro et al, 2001;Kelemen et al, 2006;Guzzetta et al, 2005;Andrade-Machado et al, 2012;Sánchez Fernán-dez et al, 2012;Loddenkemper et al, 2012;Quigg and Noachtar, 2012). Hegyi et al, (2014) in their study of 33 patients with ESES attending the Bethesda Hospital, Budapest, identified sleep EEGs in 171 records, on average 5/patient and wake recordings in 492 records, on average 15/patient).…”

Pseudo-Lennox Syndrome: Clinical and Electroencephalographic Characteristics

“…В этиологии СПЛ ведущую роль отводят генети-ческим факторам, а также возможности поражения таламуса в перинатальном периоде с нарушением таламо кортикальных связей [12,29,30]. H.Р.…”