Temel TOMBUL, Aysel MİLANLIOĞLU, Ömer Faruk ODABAŞ

A Cause of Intractable Epilepsy: Bilateral Posterior Agyria-Pachygyria

Bu vakada mental retardasyon, epilepsi ve bilateral posterior agiri-pakigirili hastanın elektro-klinik bulgularını sunduk. Klinik bulgular sıklıkla tonik jeneralize daha nadir olarak da miyoklonik ve absans nöbetleri ile karakterizeydi. İnteriktal elektroensefalografi (EEG) posterior bölgelerde senkron veya asenkron delta dalgası özellikle sağda daha belirgin diken dalga aktivitesi ve hızlı alfa ritmini gösterdi. Serebral manyetik rezonans görüntüleme bilateral, simetrik paryeto-oksipital loblarda kalınlaşmış korteks ve beyaz cevher volümünde azalmayı ortaya koydu. Sonuç olarak, mental retarde ve dirençli epilepsisi olan interiktal EEGsi posterior fokal epileptiform anormallikler, diffüz çoklu-diken dalga paroksizmleriyle karakterize hastalarda bilateral paryeto-oksipital agiri-pakigiri muhtemel etiyoloji olarak akla gelmelidir.

Dirençli epilepsi nedeni olarak bilateral posterior agiri-pakigiri

In this case, we presented the electro-clinical findings in a patient with mental retardation, epilepsy and bilateral posterior agyria-pachygyria. Clinical findings were characterized by frequent tonic generalized and scarcely with myoclonic and absence seizures. Interictal electroencephalography (EEG) showed synchronous and asynchronous delta waves in the posterior region, spike activity predominantly on the right side and fast alpha rhythms. Cerebral magnetic resonance imaging revealed bilateral, symmetric thickened cortex in the parieto-occipital lobes and reduced volume of white matter. These findings were compatible with agyria and pachygyria of posterior regions of the brain. Consequently, in the patient with mental retardation and intractable epilepsy characterized by interictal EEG with posterior focal epileptiform abnormalities, diffuse polyspike-wave paroxysms, bilateral parieto-occipital agyria-pachygyria should be considered as a possible etiology.

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