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Ann Clin Transl Neurol. 2018 Nov 12;6(1):167-173. doi: 10.1002/acn3.695. eCollection 2019 Jan.

Pilomotor seizures marked by infraslow activity and acetazolamide responsiveness.

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Krembil Brain Institute Division of Neurology University Health Network University of Toronto Toronto Canada.
Mitchell Goldhar MEG Unit Clinical Neurophysiology Laboratory Toronto Western Hospital University of Toronto Toronto Canada.


A patient with pilomotor seizures post anti-LGI1 limbic encephalitis, refractory to immunotherapy and anti-epileptic drugs, was investigated with electroencephalography and magnetoencephalography. Seizures occurred daily (14.9 ± 4.9/day), with catamenial exacerbation, inducible by hyperventilation. Anterior temporal ictal onsets were heralded (by ~15 sec) by high amplitude ipsilateral electromagnetic infraslow activity. The catamenial/ventilatory sensitivity and the infraslow activity (reflecting glial depolarization) suggested an ionic, CO 2/pH-related glioneuronal mechanism. Furosemide decreased seizure frequency by ~33%. Acetazolamide led to immediate seizure freedom, but lost efficacy with daily treatment. A cycling acetazolamide regimen (2 days on, 4 days off) plus low-dose topiramate maintained >95% reduction (0.5 ± 0.9/day) in seizures.

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