Bitemporal independent 3-Hz spike-and-waves in adult patient with idiopathic generalized epilepsy and Graves disease

Amayak Broutian, Snezhana Dolgova, Alexandra Belyakova-Bodina, Ann aAbramova, Anastasia Lukianova, Tatiana Noskova
Clinical Neurophysiology Practice. Volume 5, 2020, Pages 206-208 
Objective: We present a case of idiopathic generalized epilepsy (IGE) with seizures manifesting in thecontext of Graves disease and unusual interictal EEG pattern of bilateral independent 3 Hz spike andwave activity.
Case report: A 33-year old man with three generalized tonic-clonic seizures (GTCS) in history admittedfor overnight video-EEG. At the age of 28, he had his first seizure soon after being diagnosed with Graves’ disease. For four years, he received thiamazole and then underwent total thyroidectomy. EEGshowed a high number of generalized 3-Hz spike-and-wave discharges (GSWD) but also revealed numer-ous runs of bitemporal independent lateralized 3-Hz spike-and-wave activity (LSWA). GSWD and LSWAwere mostly independent and had slightly different morphology. A diagnosis of IGE with GTCS uponawakening was made. On levetiracetam therapy, the patient demonstrated no seizure recurrence during2-year follow-up. Repeated overnight EEG showed significant GSWD reduction and complete LSWA sup-pression.
Discussion: To our knowledge, in patients with IGE, strictly lateralized spike-and-wave activity was neverreported. In this case, thyroid dysfunction seemed to increase propensity to generate spontaneous sei-zures. We speculate that thyroid dysfunction superimposed on IGE thalamocortical network oscillationsresulted in uncommon bitemporal independent LSWA.
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