Schizencephaly and epileptic seizures: case report

Abstract

Introduction: Epileptic seizure is an acute episode of stereotypical motor, sensorial and behavioral manifestations, which is caused by the result of excessive and abnormal activity of a neuronal population. The etiology of seizures is multifactorial, thus the modern principles in approaching them include: l.Thourough clinical assessment 2. Exclusion of triggering factors 3. Establishing the correct underlying disorder with the help of methods like: Cerebral CT- scan, Video EEG, MRI -scan. 4. Conservative or surgical treatment based on the etiology of the process. Purpose and objectives: To establish the correct underlying disorder with the help of methods like: Cerebral CT- scan, Video EEG, MRI -scan. Deciding whether to choose a conservative or surgical treatment based on the etiology of the process. Materials and Methods: We report a case of a 34-year old male, diagnosed in childhood with infantile cerebral palsy with moderately spastic tetra paresis, preponderantly on the right side. The patient has never been investigated with imagistic methods. At the age of 30, he developed first episode of seizure activity and during the following months started experiencing up to 5-6 epileptic occurrences per month. All episodes were partial complex motor in the right hemibody with secondary generalization. He was admitted at the National Scientific-Practice Center of Emergency Medicine for farther investigations and treatment. On admission patient was complaining of diffuse headache, weakness in limbs, mostly on the right and walking disorders. The results of the CBC, biochemistry sample, coagulogram and lipidogram and urine, all were within normal limits. The Video EEG trace pointed out focal epileptiform discharges: F-T right, periodically extended P right. CT- scan with contrast consistent with occlusive porencephaly and MRI 3T showed subtotal lack of left hemisphere presented by a cystic defect (141x54x108 mm) communicating with subarachnoid space and ventricular system. Atrophic changes associated with the loss of structural architectonics of hippocampus structure on the left. Schizencephaly. Neurosurgery diagnosed the patient with occlusive hydrocephalus with a gigantic hemispherical cyst on the left with recommendations for endoscopic drainage of cystic cavity with basal cisterns via Stookey Method. The patient underwent the surgery and was started on anti-seizure treatment with carbamazepine 600 mg twice a day. Results and Discussions: According to the imaging studies, the initial diagnosis of infantile cerebral palsy has been infirmed and the diagnosis of occlusive hydrocephaly with a gigantic hemispherical cyst on the left has been established which was the cause of seizures. The overall patient’s state of health has improved and the seizures episodes have been controlled, and to our knowledge he has developed only 3 episodes of seizures in the past 10 months. Conclusions: The elucidation of the etiology of epileptic seizures in every particular case using different clinical and imagistic methods is crucial because the efficacy of the treatment and the quality of patient’s life depends on it.