Fig. 1

(a–d) The serial real-time transcranial Doppler ultrasound–sleep-deprived video electroencephalogram (TCD-SDvEEG). F (fluctuation of CBFV) = peak CBFVm – baseline CBFVm)/baseline CBFVm. (a) August 2017, after the seizure, drooling and dysarthria were recurrent. Involuntary emotional movements of the face were apparent, besides decreased speech output with moderate dysarthria. EEG: ESES, 95% SWI. TCD tracings had no change during NREM sleep, F > 35% (37.5%). (b) After IVIG (1 g/kg for 2 days) and high-dose methylprednisolone therapy [10 mg/(kg · d) for 3 days, followed by 5 mg/(kg · d) for 3 days], the seizure was controlled, with no drooling and fluency in the language as earlier. EEG: ESES, obviously on the right side, 90% SWI. TCD tracing from light sleep to deep sleep was similar to that in healthy children, F < 25% (23.8%). (c) The patient had frequent seizures with left eye blinking, drooling, and slightly unfluent language 1 week after prednisone withdrawal. EEG: ESES, 95% SWI. TCD tracings had no change during NREM sleep, F > 35% (44%). (d) After 3-day high-dose MPN course of 10 mg/(kg · d), followed by a 3-day course of 5 mg/(kg · d), and then oral prednisolone 2 mg/(kg · d) for a month, no seizure was observed, and cognition and language showed continuous improvement. EEG: 40% SWI. TCD tracing from light sleep to deep sleep was similar to that in healthy children, F < 30% (26.6%)