A multimodal diagnostic approach for lateralised rhythmic delta activity in the ictal-interictal continuum

Maddalena Spalletti, Francesca Pescini, Davide Gadda, Benedetta Piccardi, Maenia Scarpino, Riccardo Carrai, Cristina Boccardi, Antonello Grippo, Aldo Amantini

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalEpileptic disorders : international epilepsy journal with videotape
DOIs
Publication statusAccepted/In press - Jun 15 2020

Keywords

  • ictal-interictal continuum
  • lateralised rhythmic delta activity (LRDA)
  • non-convulsive status epilepticus
  • perfusion imaging
  • stroke-mimics

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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