John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the

Regression of stroke-like lesions in MELAS-syndrome after seizure control Volume 12, numéro 4, December 2010

Krankenanstalt Rudolfstiftung, Institute of Radiology Urania, Vienna, Austria
  • Mots-clés : epilepsy, seizures, mitochondrial disorders, metabolic disease, antiepileptics, MELAS
  • DOI : 10.1684/epd.2010.0338
  • Page(s) : 330-4
  • Année de parution : 2010

There are some indications that seizure activity promotes the development of stroke-like episodes, or vice versa, in patients with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome or other syndromic mitochondrial disorders. A 41-year-old Caucasian female with MELAS syndrome, presenting with short stature, microcytic anaemia, increased blood-sedimentation rate, myopathy, hyper-gammaglobulinaemia, an iron-metabolism defect, migraine-like headaches, and stroke-like episodes, developed complex partial and generalised seizures at age 32 years. Valproic acid was ineffective but after switching to lamotrigine and lorazepam, she became seizure-free for five years and stroke-like episodes did not recur. Cerebral MRI initially showed enhanced gyral thickening and a non-enhanced T2-hyperintensity over the left parieto-temporo-occipital white matter and cortex and enhanced caudate heads. After two years without seizures, the non-enhanced hyperintense parieto-temporo-occipital lesion had disappeared, being attributed to consequent seizure control. The caudate heads, however, remained hyperintense throughout the observational period. This case indicates that adequate seizure control in a patient with MELAS syndrome may prevent the recurrence of stroke-like episodes and may result in the disappearance of stroke-like lesions on MRI.