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Bilateral independent periodic lateralised epileptiform discharges at presentation followed by rapid recovery: novel observations from a case of Epstein-Barr virus encephalitis
  1. Rajesh Shankar Iyer1,
  2. Ramakrishnan Tirupur Chinnappan Ramalingam2,
  3. Saleem Akhtar2 and
  4. Shabeer Ponnadan2
  1. 1 Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
  2. 2 Neurology, KG Hospital, Coimbatore, Tamil Nadu, India
  1. Correspondence to Dr Rajesh Shankar Iyer, dr_rsh{at}


Bilateral independent periodic lateralised epileptiform discharges (BIPLEDs) in electroencephalograms (EEGs) are commonly caused by anoxic encephalopathy and central nervous system infections. They are associated with coma and high mortality and are thus markers of poor prognosis. We present a case of encephalitis who presented with BIPLEDs in EEG. Though the clinical, EEG and MRI features closely resembled herpes simplex encephalitis, further investigations proved it to be Epstein-Barr virus (EBV) encephalitis. Despite the presence of BIPLEDs in the EEG, the patient had a rapid clinical response to therapy with acyclovir. We emphasise that BIPLEDs may not always indicate poor prognosis especially in the setting of EBV encephalitis.

  • infection (neurology)
  • neuroimaging

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  • Contributors RSI was involved in the conception, acquisition and analysis of data and drafting the article. RTCR, SA and SP were involved in the analysis and interpretation of data and contributed towards intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.