Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Review Article Volume 3 Issue 9

PLEDs and NCSE: To Split or Lump them Together?

Keni Ravish Rajiv, Deepak Menon and Ashalatha Radhakrishnan*

Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute For Medical Sciences and Technology, Trivandrum, Kerala, India

*Corresponding Author: Ashalatha Radhakrishnan, Professor of Neurology and Epileptologist, Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.

Received: July 26, 2020; Published: August 31, 2020



Periodic lateralised epileptiform discharges are electrophysiological biomarkers of acute and sometimes chronic brain injury. A major controversy through the years has been whether PLEDs are truly ictal or just interictal or post-ictal epiphenomenon, and whether these discharges warrant any treatment. In this review, we aimed to critically analyze this issue of whether to actively treat or wait and watch PLEDs in various situations. We conclude that the etiology of PLEDs, depth of encephalopathy and presence of clinical seizures is associated with poor outcome rather than presence of PLEDs per se. Continuous EEG monitoring is warranted to recognise ictal or high risk interictal EEG patterns akin to NCSE before treating aggressively with antiepileptic drugs.

Keywords: PLEDs; BiPLEDs; Seizures; NCSE; Outcome



  1. Walsh JM and Brenner RP. “Periodic lateralized epileptiform discharges long-term outcome in adults”. Epilepsia 28 (1987): 533-536.
  2. De la Paz D and Brenner RP. “Bilateral independent periodic lateralized epileptiform discharges. Clinical significance”. Archives of Neurology 38 (1981): 713-715.  
  3. Kuroiwa Y and Celesia GG. “Clinical significance of periodic EEG patterns”. Archives of Neurology 37 (1980): 15-20.
  4. Porecha HP and Reilly EL. “Clinical Correlations of Periodic Lateralized Epileptiform Discharges”. Clinical Electroencephalography 8.4 (1977): 191-202.
  5. Kaplan PW. “EEG criteria for nonconvulsive status epilepticus”. Epilepsia 48 (2007): 39-41.
  6. Leitinger M., et al. “Salzburg Consensus Criteria for Non-Convulsive Status Epilepticus--approach to clinical application”. Epilepsy and Behavior 49 (2015): 158-163.
  7. Reiher J., et al. “Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures”. Electroencephalography and Clinical Neurophysiology 78.1 (1991): 12-17.
  8. Kate MP., et al. “Long-term outcome and prognosis of patients with emergent periodic lateralized epileptiform discharges (ePLEDs)”. Seizure 21.6 (2012): 450-456.
  9. Rai V., et al. “Continuous EEG predictors of outcome in patients with altered sensorium”. Seizure 22.8 (2013): 656-661.
  10. Ahmad Solaiman A., et al. “When Should We Treat Periodic Lateralized Epileptiform Discharges (PLEDS) (P5.061)”. Neurology 82.10 (2014).
  11. Chatrian GE., et al. “The significance of periodic lateralized epileptiform discharges in EEG: an electrographic, clinical and pathological study”. Electroencephalography and Clinical Neurophysiology 17 (1964): 177-193.
  12. Garzon E., et al. “Serial EEG during human status epilepticus: evidence for PLED as an ictal pattern”. Neurology 57.7 (2001): 1175-1183.
  13. Assal F., et al. “SPECT in periodic lateralized epileptiform discharges (PLEDs): a form of partial status epilepticus?” Seizure 10 (2001): 260-265.
  14. Hisada K., et al. “Magnetoencephalographic analysis of periodic lateralized epileptiform discharges (PLEDs)”. Clinical Neurophysiology 111 (2000): 122-127. 
  15. Aye SM., et al. “Periodic lateralized epileptiform discharges (PLEDs) in cerebral lupus correlated with white-matter lesions in brain MRI and reduced cerebral blood flow in SPECT”. Lupus 22 (2013): 510-514.
  16. Lee JW. “EEG in the ICU. What should one treat, what not?” Epileptologie 29 (2012): 210-217.
  17. Trinka E and Leitinger M. “Which EEG patterns in coma are nonconvulsive status epilepticus?” Epilepsy and Behavior 49 (2015): 203-222.


Citation: Radhakrishnan., et al. “PLEDs and NCSE: To Split or Lump them Together?".Acta Scientific Neurology 3.9 (2020): 136-139.


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