Cerebellar seizures

Report of 2 cases

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Epilepsy, especially with refractory seizures, is thought to arise only from cortical lesions or substrate. The authors report on 2 patients with refractory epilepsy and cerebellar lesions. Depth electrodes were placed within the cerebellar lesions in both patients, and intracranial electroencephalographic recordings showed seizure origin from the cerebellar lesions. One patient eventually attained seizure control with antiepileptic drugs. The other case involved a child with generalized myoclonic epilepsy associated with a pilocytic astrocytoma of the cerebellum. This patient obtained seizure control following gross-total resection of the tumor.

Abbreviations used in this paper:EEG = electroencephalography; LGG = low-grade glioma.

Article Information

Address correspondence to: Frederick A. Boop, M.D., Semmes-Murphey Clinic, 6325 Humphreys Blvd., Memphis, TN 38120. email: FABoop@aol.com.

Please include this information when citing this paper: published online June 28, 2013; DOI: 10.3171/.2013.5.PEDS1394

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Axial T1-weighted noncontrasted images demonstrating the cerebellar expansile lesion with a 4-contact depth electrode placed into the stereotactic biopsy tract for ictal recording. Note the hyperintense signal from the previous biopsy tract as well.

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    Case 1. This EEG reading demonstrates the onset of the cerebellar seizure as recorded from the 4-contact depth electrode. The first 3 channels are bipolar recordings linking electrodes 1 to 2, 2 to 3, and 3 to 4. The second 4 channels are referential recordings linked to a surface electrode. Note the change in background rhythm to a rhythmic high-voltage theta at the onset of the seizure.

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    Case 2. Sagittal (A) and coronal (B) T1-weighted Gd-enhanced images demonstrating residual partially enhancing tumor within the right cerebellar hemisphere and extending to the tentorial incisura. A postoperative anteroposterior skull x-ray (C) was obtained following Stage I surgery, demonstrating 2 depth electrodes in place, a 6-contact depth electrode at the superior aspect of the tumor, and a 4-contact depth electrode at the inferior aspect of the tumor.

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    Case 2. A: Scalp-recorded EEG study showing generalized epileptiform bursts and a generalized burst followed by generalized attenuation associated clinically with a myoclonic seizure (arrow) characterized by a brief nod of the head and vocalization. B: An EEG recording from depth and scalp electrodes capturing a similar myoclonic seizure. The burst clearly begins near the depth electrode (arrow) and spreads over 20 msec to the rest of the electrodes.

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    Case 2. A T1-weighted nonenhanced coronal MRI study obtained 1 year after resection of the pilocytic astrocytoma, at a point in time when the child had remained seizure free—but while he still needed treatment with anticonvulsant medications (lamotrigine and ethosuximide)—demonstrating postsurgical changes within the resection cavity with no residual tumor.

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