![]() ![]() The patient has remained seizure free (Engel class 1A) to date, and has integrated well into his previous work as a farmer. A routine EEG performed in March 2018 showed no epileptiform activity, and antiepileptic treatment was suspended. In February 2016, we performed a standard anterior temporal lobectomy with right amygdalohippocampectomy the patient continued receiving carbamazepine in monotherapy. These findings confirmed the localisation of the epileptogenic zone in the right hippocampus. The study detected interictal activity similar to that recorded in previous EEG studies, with 3 electrically identical stereotyped seizures: fast, low-amplitude activity in contacts 1 and 2 of the right FOE, of 7 seconds’ duration, with secondary propagation to contacts 1 and 2 of the left FOE, where amplitude clearly increased, and subsequently to electrodes F8, T4, and T6, with progressive rhythmic theta activity ( Fig. 1B) and performed complementary vEEG-s (reference montage), of 48 hours’ duration. ![]() We bilaterally implanted foramen ovale electrodes (FOE 1 × 5) ( Fig. Physical examination revealed anxiety, bradypsychia, and poor short-term memory, with no other abnormalities. Ictal and interictal SPECT studies were inconclusive. Neuropsychological evaluation revealed mild to moderate attentional and language impairment, very low intelligence quotient score, and moderate verbal and visuospatial memory impairment. Video EEG with surface electrodes (vEEG-s), lasting 96 hours, revealed bilateral temporal interictal epileptiform activity, predominantly in the right hemisphere, and 8 identical ictal events with initially unilateral rhythmic theta waves in the temporal region onset was left-sided on 6 occasions and right-sided on 2. The patient was receiving polytherapy with lacosamide, lamotrigine, phenobarbital, and carbamazepine. Seizures presented as a sensation of penetration of thought, an urge to run away, anxiety, disconnection from his setting, and automatisms, with post-ictal confusion seizure duration was 2 minutes, with a frequency of 2-3 episodes per month. ![]() We present the case of a 45-year-old right-handed man with a 12-year history of drug-resistant TLE-HS, who had suffered mild head trauma at the age of 7 years. Rare cases have been described of patients with temporal lobe epilepsy due to unilateral hippocampal sclerosis (TLE-HS), presenting epileptiform activity contralateral to the hippocampal atrophy, or with bilateral activity, in the so-called burned-out hippocampus syndrome, 1 which presents with false lateralisation of seizure onset and electro-clinico-radiological incongruity and requires invasive evaluation. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |