Focal epilepsy recruiting a generalised network of juvenile myoclonic epilepsy: a case report

Abstract

We report a patient with juvenile myoclonic epilepsy who subsequently developed temporal lobe epilepsy, which gradually became clinically dominant. Video telemetry revealed both myoclonic seizures and temporal lobe seizures. The temporal lobe seizures were accompanied by a focal recruiting rhythm with rapid generalisation on EEG, in which the ictal EEG pattern during the secondary generalised phase was morphologically similar to the ictal pattern during myoclonic seizures. The secondary generalised seizures of the focal epilepsy responded to sodium valproate, similar to the myoclonic epilepsy. In this rare case of coexistent Juvenile Myoclonic Epilepsy and Temporal lobe epilepsy, the possibility of focal epilepsy recruiting a generalised epileptic network was proposed and discussed.

Case Report: Focal, generalized, or both: does generalized network involvement preclude successful epilepsy surgery?

“…Given the network overlaps, frontal lobe epilepsy tends to involve existing widespread brain networks ( Bancaud et al, 1974 ; Kakisaka et al, 2011 ). This contrasts with temporal lobe epilepsy with few examples of generalized network recruitment in the literature; if generalized EEG changes are present, they often occur in the context of co-existent focal and generalized epilepsy ( Khaing et al, 2014 ). Though there are no clear predictors for such network involvement, lesions arising in anatomical brain regions that are already richly bilaterally connected (e.g., frontal and cingulate regions) appear to be more vulnerable ( Tukel and Jasper, 1952 ; Blumenfeld et al, 2009 ; Chen et al, 2016 ).…”

Genetic generalized epilepsies with frontal lesions mimicking migratory disorders on the epilepsy monitoring unit

“…One may be reminded of several tendencies and suggestions from the period covered here that might have contributed to the tendency to consider some of these cases as focal rather than generalized: There is a growing literature reporting on patients with a coincidence of focal (mainly temporal lobe) epilepsy and genetic generalized epilepsies showing a worthwhile improvement of epilepsy after resection of the lesion “Mixed” ictal EEG patterns have been described in patients with the coexistence of generalized and focal epilepsy, where focal seizures either evolved from generalized spike waves or focal seizures recruited a generalized network Symptomatic epilepsies may imitate genetic (“idiopathic”) generalized epilepsies …”