Posterior Terminus for Migrating Lateralized Periodic Discharges
Abstract number :
3.156
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2022
Submission ID :
2204347
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:24 AM
Authors :
Nydia Kung, BS – Pritzker School of Medicine, University of Chicago; Naoum Issa, MD, PhD – Associate Professor, Neurology, University of Chicago
Rationale: Lateralized periodic discharges (LPDs) are electroencephalographic markers of cerebral irritability that consist of sharp waves in a periodic pattern over a region of the brain. They are typically observed in critically ill patients who have large cortical abnormalities and are often found in patients who also have seizures. There are several variants of LPDs with different implications for treatment and outcome. Here we describe a new LPD pattern in which the location of LPDs migrate from a frontal location to an occipital location.
Methods: This is an observational, retrospective case series of hospitalized patients in whom LPDs were noted to migrate from a frontal location to a posterior location on EEG. Clinical course, electrographic features, and magnetic resonance images were reviewed. Patient outcome was determined based on the documented Modified Rankin score at discharge._x000D_
Results: This is a series of cases in which LPDs are initially identified in a frontal site, sometimes close to a frontal cortical abnormality, but over the course of hours or days the LPDs migrate to a posterior location. Common features in the cases include: (1) unilateral, frontal LPDs around the time of symptom onset, (2) migration, over days, of LPDs to an occipital location, (3) resolution of motor symptoms, but not improvement of mental status, with the transition from frontal to parieto-occipital locations, (4) cortical ribboning on MRI over the region involved with the posterior LPDs, and (5) MRI changes in the ipsilateral pulvinar nucleus. Each patient in the series had a poor clinical outcome defined as a Modified Rankin score of 4 or 5 at discharge or entering hospice or dying within 6 months of presentation.
Conclusions: Based on the electrographic and imaging findings, this subtype of migrating LPD is mediated subcortically, through thalamo-cortical connections to and from the pulvinar nucleus. The clinical outcomes suggest that migrating LPDs could portend poor functional outcome, although it might be possible to tailor interventions to reduce morbidity if the LPD subtype can be identified early.
Funding: None
Neurophysiology