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From the Montreal Neurological Institute and Hospital (Drs. Gurses, Gross, Bastos, Dubeau, Andermann, and Melanson), McGill University, Montreal, Quebec, Canada; Istanbul University Neurological Sciences Institute (Drs. Gurses, Calay, and Eraksoy), Department of Neurology, and Turkish Spastic Children’s Society (Dr. Bezci), Department of Pediatrics, Istanbul, Turkey.
Address correspondence and reprint requests to Dr. Frederick Andermann, Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada H3A 2B4.
OBJECTIVE: To study the incidence and pattern of epilepsy in patients with periventricular leukomalacia (PVLM) in two specialty clinic settings.
BACKGROUND: Motor and cognitive deficit as well as epilepsy are common in patients with PVLM. With modern imaging techniques, PVLM is now easily recognized.
METHODS: Epileptic seizures and syndromes as well as motor and cognitive deficits were correlated with MRI findings. Two patient populations were studied: Group A—children with cerebral palsy and PVLM presenting to a center for children with motor disability (n = 19); and Group B—epileptic patients with PVLM presenting to a tertiary epilepsy center (n = 12). A single patient with PVLM and epilepsy who underwent extensive investigations, including intracranial EEG telemetry, is reported.
RESULTS: In Group A, 47% of patients had epilepsy (9/19). PVLM was found in 1.27% of patients investigated for epilepsy at a tertiary epilepsy center (12/942). The majority of patients in both groups had multiple seizure types, with complex partial seizures being most common. Of patients with seizures (Groups A and B), 85.7% had intractable epilepsy (18/21). Intracranial EEG in the illustrative case demonstrated a multifocal epileptic process with occipitotemporal predominance.
CONCLUSIONS: PVLM was an uncommon underlying cause in patients presenting with epilepsy (Group A); however, patients presenting with motor disability and PVLM (Group B) had a high incidence of seizures. PVLM in epileptic patients is associated with multiple seizure types and medically refractory disease.
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