complex partial seizures and choroid plexus cysts

[Mom/RN]

My 6 year old son was diagnosed with partial complex seizures in May after  his teacher reported an episode of staring, lips quivering & he was unable to respond to her questioning . The episode lasted a few minutes according to the teacher. An EEG was done as part of the work up and he was noted to have slowing on the right side occipital area, no epiliptiform activity.  My son had three other episode in the car where he would be talking and interacting appropriately then appear to suddenly be "asleep" diaphoretic and unable to be aroused.  he would awaken after 5 minutes or so. he was never incontinent or showed signs of impaired breathing during these episodes. He was started on trileptal bid and has had no further episodes.  A repeat EEG in august after being medicated for 3 months again showed slowing on the right side no epileptiform activity.  An MRI done this summer showed bilateral choroid plexus cysts.  The neurologist states these are probably an incidental finding, however in light of neurological symptoms I question this. What does the slowing indicate on the EEG?  My son is a very bright, social child, otherwise perfectly healthy. The plan is to try to withdraw medication 2 years after the last event. What is the likelyhood this will subside not presenting any more seizure episodes?  I sincerely appreciate your expert opinion! Thank you.

[CCF-Neuro-M.D.-PW]

Epilepsy can be suspected clinically based on history alone, and treated, although we usually like to have an EEG abnormality documented. I cannot interpret the EEG specifically as it can be quite subjective. In general, slowing does not constitute epilepsy or seizures, and is quite non-specific - just meaning either dysfunction or a structural lesion in that area. If slowing is present in just one area, an MRI should be done (and in most cases of new onset epilepsy) to look for a structural abnoramlity that might be causing the epilepsy. The choroid plexus cysts if small are probably not causeing the seizures, but could if large cause episodes of unresponsiveness by blocking the CSF pathways - this should be apparent on the scan. The prognosis depends on the cause, but it is encouraging that the events have stopped and the MRI is otherwise normal. It is also important to consider things that can mimic seizures (esp if there is no epilepsy on the EEG or MRI) like heart rhythm problems etc

[CassandNico]

A related discussion, Epilepsy and choroid plexus cysts was started.