Misleading lateralization by ictal SPECT in temporal lobe epilepsy-- a case report.
A 28-year-old woman with temporal lobe epilepsy underwent presurgical evaluation. Scalp-EEG showed non-localizing seizure patterns. MRI revealed a right hippocampal sclerosis. Ictal HMPAO-SPECT showed a marked left temporal hyperperfusion. Video-EEG monitoring with foramen ovale electrodes (FOE) showed an initial seizure pattern which appeared in the right FOE and which shifted to the left 8 s after clinical onset. Three years after a right temporal lobectomy, the patient is seizure-free. In conclusion, although the ictal SPECT suggested a left temporal seizure focus, the intracranial EEG and the postoperative seizure-freedom confirmed the right-sidelocation of the epileptogenic region. A rapid right-left seizure spread explains the mechanism of falsely lateralizing ictal SPECT.
Janszky
J
J
Epilepsy Center, National Institute of Psychiatry and Neurology, Budapest, Hungary. janszky@opni.hu
Holló
A
A
Barsi
P
P
Rásonyi
G
G
Erõss
L
L
Kalóczkai
A
A
Halász
P
P
D000328:Adult; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D013702:Temporal Lobe / Q000473:pathology* / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon