title: Tooth-brushing epilepsy: a report of a case with structural and functional imaging and electrophysiology demonstrating a right frontal focus.
abstract: Patients with reflex epilepsies may provide insights into cerebral pathophysiology. We report a patient with an unusual form of reflex epilepsy in whom seizures are induced by tooth brushing. Magnetic resonance imaging (MRI) demonstrated a right posterior frontal low-grade tumor predominantly involving the precentral gyrus. Video-telemetry demonstrated right-sided epileptiform activity during a typical induced complex partial seizure. An ictal single photon emission computed tomography (SPECT) scan showed an area of hyperfusion that corresponded to the MRI lesion on coregistration with a surface-matching technique. A subsequent coregistered interictal SPECT scan demonstrated hypoperfusion in the same region. Ours is the first report to demonstrate a structural focus in this unusual form of reflex epilepsy. Possible mechanisms to explain the induction of the seizures are discussed.
authors.affiliation: Department of Clinical Neurosciences, St. Vincent's Hospital, Victoria, Australia.
authors.forename: T J
authors.initials: TJ
authors.lastname: O'Brien
authors.forename: R E
authors.initials: RE
authors.lastname: Hogan
authors.forename: L
authors.initials: L
authors.lastname: Sedal
authors.forename: V
authors.initials: V
authors.lastname: Murrie
authors.forename: M J
authors.initials: MJ
authors.lastname: Cook
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D017029:Epilepsy, Complex Partial / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014099:Toothbrushing / Q000009:adverse effects*