Transient lesion in the splenium of the corpus callosum and a sudden antiepileptic drugs withdrawal: A case with focal epilepsy in presurgical evaluation

Abstract

Introduction. A sudden withdrawal of antiepileptic drugs gives higher rate of epileptic seizures in the settings of video electroencephalography (vEEG), monitoring that is a subject to further registration and analysis. A very rare complication of this method is transient lesion of the splenium of corpus callosum (SCC) detected with brain MRI. Case report. We presented a patient with a 5-year history of pharmacoresistant epilepsy admitted to the Institute of Neurology (August, 2008) for vEEG monitoring. Interictal epileptic discharges but none seizure were recorded after the sudden withdrawal of antiepileptic medications, during 5 days of vEEG monitoring Initial brain MRI three days after vEEG monitoring revealed focal lesion in SCC, hyperintense on T2 and FLAIR sequence. A longitudinal radiological follow-up (7 and 49 days after initial acquisition) confirmed transient nature of the lesion without diffusion coefficient changes. Conclusion. SCC lesion, reversible and harmless, may occur after a sudden antiepileptic withdrawal. Its early detection makes further extensive neuroradiological and clinical examinations unnecessary.Uvod. Naglo ukidanje antiepilepticke terapije u pripremi za video-elektroencefalografiju (vEEG), predstavlja metodu za ucestavanje epileptickih napada zbog registrovanja i detaljne analize. Vrlo retka komplikacija tog postupka je pojava prolazne lezije u splenijumu korpusa kalozuma (SKK) registrovana na magnetnoj rezonanci (MRI) mozga. Prikaz slucaja. Prikazana je bolesnica sa farmakorezistentnom epilepsijom primljena u Institut za neurologiju Klinickog centra Srbije avgusta 2008. godine radi vEEG monitoringa. U cilju izazivanja epileptickih napada naglo je obustavljana antiepilepticka terapija, a u petodnevnom vEEG monitoringu registrovana je epileptiformna interiktalna aktivnost, bez epileptickih napada. Inicijalnim MRI pregledom tri dana posle vEEG monitoringa otkrivena je fokalna lezija SKK, hiperintenzna na T2 i FLAIR sekvencama, za koju je longitudinalnim radioloskim pracenjem (7 i 49 dana posle incijalnog snimanja) pokazano da je tranzijentna, bez promene difuzionih koeficijenata. Zakljucak. Lezije u SKK su reverzibilne, bezopasne i verovatno nastaju zbog naglog ukidanja antiepileptickih lekova. Njihovo rano prepoznavanje cini dalja ekstenzivna neuroradioloska i klinicka ispitivanja nepotrebnim.