ObjectiveThe aim was to summarize the seizure and video electroencephalogram (VEEG) characteristics of Dyke-Davidoff-Masson syndrome (DDMS). Methods The case data of four patients with Dyke-Davidoff-Masson syndrome (DDMS) who attended the Epilepsy Center of Hunan Provincial Brain Hospital from March 2022 to March 2023 were retrospectively analyzed to summarize the clinical manifestations of their seizures and the characteristics of their video electroencephalogram (VEEG). Results One case of symptomatic epilepsy with focal seizures; VEEG showed poor background activity alpha rhythmic modulation, amplitude modulation, and increased distribution of slow wave activity in the left frontal and temporal regions; bilateral frontal-central and anterior-temporal regions (more so on the left side), with sharp and slow composite wave issuance.Two cases of symptomatic epilepsy with focal seizures progressing to generalized seizures; in one case, the VEEG showed: background activity α-rhythmic modulation, amplitude modulation is possible, the left frontal, central, anterior temporal region slow wave increase; the left frontal central, parietal anterior temporal region spike-like slow wave activity mixed with spike wave, spike-slow complex wave short-medium-range issuance; the other VEEG showed: background activity α-rhythmic modulation, amplitude modulation is possible, the right frontal central, anterior temporal region slow wave increase; right frontal, central, and anterior temporal region for the famous medium-extremely high-high-amplitude slow wave activity mixed with spike wave, spike-slow complex wave short-medium-range issuance. One case of symptomatic epilepsy with generalized seizures; VEEG showed bilateral occipital alpha rhythm asymmetry, right occipital region <50% of the left side, poor regulation and amplitude modulation; bilateral frontal pole, frontal region, anterior temporal region spike and spiking slow complex wave discharges (right side was prominent), and right pterionic electrodes, anterior temporal and mesial temporal spike and spiking slow wave discharges. Conclusions Epileptic seizures are one of the main clinical manifestations of DDMS and most of them are consulted after a seizure, and their seizure types tend to be focal seizures or progress to generalized seizures, and most of them are drug-refractory epilepsies. The results of VEEG monitoring tend to be characterized by abnormal background activity, increased slow-wave activity, and the site of epileptogenic wave-like discharges tends to be in line with the site of cerebral softening foci or the site of the atrophic side of the brain as shown by cranial MRI.
ObjectiveTo investigate the clinical effect of Electro-Cortico-Graphy (ECOG) monitoring on refractory epilepsy caused by double pathology. MethodsA retrospective analysis was performed on 10 patients with refractory epilepsy who underwent surgical treatment in Hunan Brain Hospital from January 2020 to December 2021. The diagnosis of postoperative disease was dual pathology of medial temporal lobe sclerosis (MTS) and focal cortical dysplasia (FCD), and the effect of oral drugs was poor. All patients underwent full preoperative evaluation to determine the scope of excision of epileptogenic lesions. Cortical electrodes were used to monitor the location and scope of epileptic discharge during the operation. Epileptogenic lesions were excised, cortical heat cautery was performed, and then cortical EEG monitoring was performed to adjust the excision strategy. The patients were followed up for 24 to 48 months, and the prognosis was assessed according to the Engel scale. ResultsAmong the 10 patients, 1 patient had acute subdural hemorrhage after surgery, 1 patient had speech and naming disorders, but all of them were recovered at discharge. The other patients had no neurological defects such as intracranial infection, hemiplegia, aphasia, etc. Engel grade I was observed in 9 cases (90%) and Engel grade III was observed in 1 case (10%). ConclusionCortical electrode monitoring is safe and effective for refractory epilepsy caused by double pathological signs.