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September 2006

Generalized Epilepsy and Classic Spike-Wave Discharges With Unilateral Thalamic Lesions

Author Affiliations

Author Affiliations: Departments of Neurology, Centre Hospitalier Université de Montréal (Hôpital Notre-Dame) (Drs Nguyen, Guilbert, and Cossette) and Hôpital Ste-Justine (Drs Podubnaia and Carmant), Montréal, Quebec.

Arch Neurol. 2006;63(9):1321-1323. doi:10.1001/archneur.63.9.1321

Background  Idiopathic generalized epilepsy (IGE) is a heterogeneous condition with a predominantly genetic origin. Clinical hallmarks of IGE syndromes include generalized spike and wave discharges and normal results on brain imaging.

Objective  To describe 2 patients with clinical presentations compatible with IGE but whose imaging studies revealed unilateral thalamic lesions.

Design  Case reports.

Setting  University-affiliated hospitals.

Patients  Two 21-year-old patients (1 man and 1 woman).

Main Outcome Measures  Magnetic resonance imaging findings.

Results  Magnetic resonance imaging unexpectedly revealed unilateral thalamic lesions.

Conclusions  We recommend doing magnetic resonance imaging studies in patients with IGE, especially in refractory or atypical cases. In rare cases, clinical features compatible with IGE may be associated with structural thalamic or other lesions.