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ID 35010
file
creator
Kagawa, Kota
Iida, Koji
Katagiri, Masaya
Nishimoto, Takeshi
Hashizume, Akira
Hanaya, Ryosuke
Arita, Kazunori
subject
Bilateral hippocampal atrophy
Intracranial EEG
Epilepsy surgery
False scalp ictal onset
NDC
Medical sciences
abstract
Patients with bilateral hippocampal atrophy (BHA) in a subgroup suffering from mesial temporal lobe epilepsy represent a therapeutic challenge. We achieved successful surgical treatment in a case with BHA and false lateralized ictal onset on video-scalp electroencephalogram (EEG). A 27-year-old male patient with seizures since the age of 15 years showed current seizures consisting of an epigastric aura, a feeling of difficulty in breathing and oroalimentary automatism, which were frequently followed by secondary generalization with right-arm tonic extension. MRI showed BHA with hyperintensity on FLAIR and a slightly smaller volume in the left hippocampus on volumetry. Ictal EEG started from the left anterior temporal and subtemporal regions, spreading to the right anterior to middle temporal region. Interictal EEG was not lateralized, and showed independent spikes in the bilateral anterior temporal and subtemporal regions. The patient underwent chronic intracranial EEGmonitoring, revealing that the seizure onset originated from the right hippocampus with a rapid spread to the hippocampus and lateral temporal cortex on the left side. We performed a right anterior temporal lobectomy with amygdalohippocampectomy. Histological diagnosis was classic hippocampal sclerosis. The patient has since been seizure-free for 4 years. In this case, false lateralization may have been caused by an atypical seizure-propagating route to the contralateral temporal region via the dorsal hippocampal commissure instead of the usual pathway to the ipsilateral temporal neocortex. The technique of bilateral intracranial EEGmonitoring is advantageous to lateralize the actual side, particularly in BHA patients even with clearly and falsely lateralized ictal onset on scalp-EEG.
journal title
Hiroshima Journal of Medical Sciences
volume
Volume 61
issue
Issue 2
start page
37
end page
41
date of issued
2012-06
publisher
Hiroshima University Medical Press
issn
0018-2052
ncid
language
eng
nii type
Departmental Bulletin Paper
HU type
Departmental Bulletin Papers
DCMI type
text
format
application/pdf
text version
publisher
rights
(c) Hiroshima University Medical Press.
department
Graduate School of Biomedical & Health Sciences
Graduate School of Biomedical Science
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