The coexistence of focal and generalized epilepsy is rare. We report on a 17-year-old male with drug-resistant focal epilepsy and idiopathic generalized epilepsy (IGE). He began to experience generalized tonic-clonic seizures (GTCS) at the age of 3 years, with a good response to phenobarbital. At the age of 14 years, he began to experience complex partial seizures (CPS). Video-electroencephalography (video-EEG) telemetry showed the coexistence of right temporal spikes and bursts of generalized spike-wave (GSW). The ictal EEG showed a unique EEG pattern characterized by a 4- to 5-second burst of GSW followed by rhythmic delta activity over the right temporal region. A magnetic resonance image (MRI) showed right hippocampal sclerosis. The patient underwent a right temporal lobectomy that significantly improved his seizure control. He was rendered seizure free of the complex partial seizures and improvement of the GTCS. This case illustrates a very uncommon ictal EEG pattern, and shows that the decision for surgery in patients with focal drug-resistant epilepsy should not be affected by coexistent generalized epilepsy.
Proposal for classification of epilepsies and epileptic syndromes. Commission on classification and terminology of the International League Against Epilepsy. Epilepsia. 1989;30:389-399.
2.
NiedermeyerE.The occurrence of generalized (centrencephalic) and focal seizure patterns in the same patients. Johns Hopkins Med J. 1968;122:11-15.
3.
GaborAJMarsanCA. Co-existence of focal and bilateral diffuse paroxysmal discharges in epileptics: clinical-electrographic study. Epilepsia. 1969;10:453-472.
4.
SadlerMRBlumeWT. Significance of bisynchronous spike-waves in patients with temporal lobe spikes. Epilepsia. 1989;30:143-146.
5.
GellerEBLancmanMEVan NessPCDinnerDS. Coexistence of generalized and partial epilepsies. Electroencephalogr Clin Neurophysiol. 1995;95:P17.
6.
LiLMO’DonoghueMFSmithSJM. Outcome of epilepsy surgery in patients with temporal lobe epilepsy associated with 3 to 4 Hz generalized spike and wave discharges. J Epilepsy. 1996;9:210-214.
7.
DiehlBWyllieERothnerADBingamanW. Worsening seizures after surgery for focal epilepsy due to emergence of primary generalized epilepsy. Neurology. 1998;51:1178-1180.
8.
KoutroumanidisMHennessyMJElwesRDBinnieCDPolkeyCE. Coexistence of temporal lobe and idiopathic generalized epilepsies. Neurology. 1999;53:490-495.
9.
NicolsonAChadwickDWSmithDF. The coexistence of idiopathic generalized epilepsy and partial epilepsy. Epilepsia. 2004;45:682-685.
10.
JehaLEMorrisHHBurgessRC. Coexistence of focal and idiopathic generalized epilepsy in the same patient population. Seizure. 2006;15:28-34.
11.
WyllieELachhwaniDKGuptaA. Successful surgery for epilepsy due to early brain lesions despite generalized EEG findings. Neurology. 2007;69:389-397.
12.
GuptaAChirlaAWyllieELachhwaniDKKotagalPBingamanWE. Pediatric epilepsy surgery in focal lesions and generalized electroencephalogram abnormalities. Pediatr Neurol. 2007;37:8-15.
13.
RadhakrishnanAMenonRNRadhakrishnanK. Coexistence of idiopathic generalized epilepsy among surgically treated patients with drug-resistant temporal lobe epilepsy. Epilepsy Res. 2011;96:151-157.
14.
MoseleyBDSinhaSMeyerFBMarshWRBrittonJF. Long-term outcomes in patients with preoperative generalized interictal epileptiform abnormalities following amygdalohippocampectomy. Epilepsy Res. 2012;99:171-175.
15.
MoseleyBDDhamijaRWirrellEC. The cessation of continuous spike wave in slow-wave sleep following a temporal lobectomy. J Child Neurol. 2012;27:113-116.
16.
EnatsuRWyllieEKotagalPBingamanW. Surgically proven coexistence of focal and generalized epilepsy: a case report. Epilepsy Behav. 2013;26:61-63.
17.
GeigerLRHarnerRN. EEG patterns at the time of focal seizure onset. Arch Neurol. 1978;35:276-286.
18.
EbersoleJSPaciaSV. Localization of temporal lobe foci by ictal EEG patterns. Epilepsia. 1996;37:386-399.
19.
AtallaNAbou-KhalilBFakhouryT. The star-stop-star phenomenon in scalp-sphenoidal recordings. Electroencephalogr Clin Neurophysiol. 1996;98:9-13.
20.
JanMMSadlerMRaheySR. Electroencephalographic features of temporal lobe epilepsy. Can J Neurol Sci. 2010;37:439-448.
21.
BlumenfeldH. Cellular and network mechanisms of spike-wave seizures. Epilepsia. 2005;46(suppl 9):21-33.
22.
MeerenHvan LuijtelaarGLopes da SilvaFCoenenA. Evolving concepts on the pathophysiology of absence seizures: the cortical focus theory. Arch Neurol. 2005;62:371-376.
23.
GuldvogBLoyningYHauglie-HanssenEFloodSBjornaesH. Predictive factors for success in surgical treatment for partial epilepsy: a multivariate analysis. Epilepsia. 1994;35:566-578.
24.
Delgado-EscuetaAVWalshGO. The selection process for surgery of intractable complex partial seizures: surface EEG and depth electrography. In: WardAA JrPenryJKPurpuraD, eds. Epilepsy. New York, NY: Raven Press; 1983:292-326.
25.
AlibertiVGrunewaldRAPanayiotopoulosCPChroniE. Focal electroencephalographic abnormalities in juvenile myoclonic epilepsy. Epilepsia. 1994;35:297-301.
26.
JayalakshmiSSSrinivasa RaoBSailajaS. Focal clinical and electroencephalographic features in patients with juvenile myoclonic epilepsy. Acta Neurol Scand. 2010;122:115-123.
27.
ItoMYamakawaKSugawaraTHiroseSFukumaGKanekoS. Phenotypes and genotypes in epilepsy with febrile seizures plus. Epilepsy Res. 2006;70(suppl 1):S199-S205.
28.
WalkerAE. The propagation of epileptic discharge. In: NiedermeyerE, ed. Epilepsy: Recent Views on Theory, Diagnosis and Therapies of Epilepsy. Basel, Switzerland: S. Karger; 1970:13-23.
29.
LombrosoCT. Consistent EEG focalities detected in subjects with primary generalized epilepsies monitored for two decades. Epilepsia. 1997;38:797-812.
