SOD Neurofisopatologia, Dipartimento Neuromuscoloscheletrico e Organi di Senso, AOU Careggi,
SOD Stroke Unit, Dipartimento DEA, AOU Careggi,
SOD Neuroradiologia, Dipartimento dei Servizi, AOU Careggi,
IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
Correspondence: Maddalena Spalletti
Azienda Ospedaliero-Universitaria Careggi,
Largo Brambilla 3, 50134,
The ictal-interictal continuum represents a diagnostic challenge even for expert neurrophysiologists, often requiring an additional multimodal diagnostic workup to understand its clinical significance. Lateralised rhythmic delta activity (LRDA) is an ictal-interictal continuum pattern that has only recently been investigated and recognised as potentially ictogenic or sometimes even ictal.
We describe a patient who presented with acute-onset aphasia, initially suspected of having a stroke; advanced brain imaging with CT-perfusion showed features suggesting regional left temporo-parietal hyperperfusion and an EEG revealed LRDA with fluctuations and intermixed sharp waves in the same areas. Treatment with lacosamide caused both clinical and EEG improvement after a few hours, supporting the hypothesis that the EEG pattern represented an ictal/interictal phenomenon.
In the literature, a correlation between metabolic/perfusion imaging and ictal-interictal continuum patterns is described regarding lateralised periodic discharges but less studied for LRDA.
In this case, we adopted a multimodal approach, integrating advanced imaging, EEG, clinical features, and response to therapy, to consider the overall clinical presentation as focal NCSE.