Apparent False Lateralization of Seizure Onset by Scalp EEG in Temporal Lobe Epilepsy Associated with Cerebral Cavernous Malformation: A Case Report and Overview.

False lateralization of ictal onset by scalp electroencephalogram (EEG) is an infrequent entity that has been reported in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (HS). In these cases, a tendency for rapid seizures that spread through the frontal-limbic system and hippocampal commissural pathways to the contralateral hemisphere has been proposed. Cerebral cavernous malformations (CCMs), which constitute a collection of abnormally configured small blood vessels with irregular structures, is a well-defined epilepsy-associated pathology. Their primary association with seizures might be explained either as a result of physiological changes affecting the cerebral cortex immediately surrounding the CCM (an epileptogenic mechanism that is relevant for both, temporal and extratemporal lesions) or as a result of promoting epileptogenicity in remote but anatomo-functionally connected brain regions, a mechanism that is particularly relevant for temporal lobe lesions. To date, there have been only two publications on falsely lateralizing ictal onsets by EEG in temporal cavernoma, but not in other regions. Here, we report a rare case of apparent false lateralization of ictal onset by scalp EEG in a patient with a left medial frontal gyrus cavernoma (supplementary motor area), and discuss some relevant pathophysiological mechanisms of false lateralization.

Human Immunoglobulin Versus Plasmapheresis in Guillain-Barre Syndrome and Myasthenia Gravis: A Meta-Analysis.

OBJECTIVES: To evaluate the efficacy and safety over a short time period of human intravenous immunoglobulin versus plasma exchange (PE) in the management of some autoimmune neurologic diseases. In addition, length of hospital stay and duration of ventilator support were compared. METHODS: Randomized controlled trials and analytical observational studies of more than 10 cases were reviewed. Cochrane Neuromuscular Disease Group trials, MEDLINE, EMBASE, HINARI, and Ovid, were searched as data source. Reference lists were examined for further relevant articles. A random-effect model was used to derive a pooled risk ratio. RESULTS: A total of 552 articles were found and 24 met the criteria for a studied population of 4657 cases: 14 articles were about Guillain-Barré syndrome and 10 of myasthenia gravis. No evidence was found to suggest that PE or intravenous immunoglobulin differed in terms of efficacy or safety to treat any of the 2 diseases. Hospital stay length and ventilatory support time are different in each illness; however, we found no statistical difference in either of the 2 treatments. CONCLUSIONS: There is no evidence for superiority in the efficacy or safety of immunoglobulin or plasmapheresis in the management of Guillain-Barré syndrome and myasthenia gravis. However, caution should be exercised in the interpretation of these results given the limitations in the quality of the evidence and the heterogeneity of the studies.