Focal sensory-motor status epilepticus in multiple sclerosis due to a new cortical lesion. An EEG–fMRI co-registration study

Video-polygraphic monitoring: low-voltage de-synchronization of EEG activity (red arrow) precede the EMG tonic activity. Then the tonic muscle contraction is associated with fast rhythmic discharge at the vertex region. Finally, the clonic phase of left Tibialis anterior muscle contraction is associated with theta activity in the same EEG derivation (b detail of a). The EEG trace does not show a clear spikes discharge at the onset of the EMG activity in accordance with the deeply location of the epileptogenic zone in the medial surface of the frontal lobe. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of the article.)

MRI pre- (a and b) and post- (c and d) disease relapse (axial FLAIR and saggital T2-weighted images). The two exams (at a 3 months interval) were acquired with the same sequence protocol and with the same 3-T Philips Achieva scan. A new small intra-cortical lesion was evident in the right paracentral lobule (c and d – red arrow). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of the article.)

fMRI results. (a) Functional map of the left foot motor area; block design; p<0.05 corrected for multiple comparison; k>5 voxels. (b) Functional map of the left foot somato-sensory cortex; event-related design; p<0.05 corrected for multiple comparison; k>5 voxels. (c) Functional map of three reflex seizures induced by left foot somato-sensory stimulation; event-related design; p<0.05 corrected for multiple comparison; k>5 voxels. Results are overlaid on the patient's T1 sagittal image (x=8).¹⁰