A case of startle epilepsy and SSMA seizures documented with subdural recordings.
OBJECTIVE
To study the mechanisms of startle-induced supplementary sensorimotor area (SSMA) seizures.


METHODS
We present a patient investigated with indwelling subdural grid electrodes covering both the SSMA and the dorsolateral frontal lobe.


RESULTS
We found a simultaneous seizure onset in the right dorsolateral premotor cortex and the right SSMA. High-resolution magnetic resonance imaging (MRI) showed a small subcortical lesion adjacent to the right SSMA. The patient became seizure free after resection of the lesion and the ictal-onset zone.


CONCLUSIONS
We conclude that an extended region of abnormally excitable tissue within the frontal lobe could facilitate the generation of startle-induced seizures. We speculate that a widespread epileptogenic zone could help to explain why some patients with SSMA or dorsolateral frontal lobe seizures are more likely to have startle-induced seizures.
Universitätskliniken für Neurologie, Vienna, Austria.
W
W
Serles
F
F
Leutmezer
E
E
Pataraia
A
A
Olbrich
G
G
Gröppel
T
T
Czech
C
C
Baumgartner
D000328:Adult; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data*; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology*; D006801:Humans; D009044:Motor Cortex / Q000503:physiopathology; D013216:Reflex, Startle / Q000502:physiology*; D013355:Subdural Space