Status gelasticus after temporal lobectomy: ictal FDG-PET findings and the question of dual pathology involving hypothalamic hamartomas.
OBJECTIVE
To present the first ictal fluorodeoxyglucose-positron emission tomography (FDG-PET) evidence of the hypothalamic origin of gelastic seizures in a patient with a hypothalamic hamartoma (HH) and to raise the issue of true dual pathology related to this entity.


METHODS
Ictal FDG-PET was acquired during an episode of status gelasticus with preserved consciousness, in a patient previously operated on for complex partial seizures (CPSs) due to a temporal lobe epileptogenic cyst.


RESULTS
Ictal hypermetabolism was localized to the region of the HH during the status gelasticus. CPSs had been completely eliminated after temporal lobe surgery.


CONCLUSIONS
Ictal FDG-PET independently confirmed that gelastic seizures in patients with HH do originate in the diencephalic lesion. An HH may coexist with another epileptogenic lesion, in a context of dual pathology.
Palmini
Andre
A
Neurology Service & Epilepsy Surgery Program, Hospital São Lucas da PUCRS, Porto Alegre, Brazil. apalmini@uol.com.br
Van Paesschen
Wim
W
Dupont
Patrick
P
Van Laere
Koen
K
Van Driel
Guido
G
D000328:Adult; D038481:Anterior Temporal Lobectomy; D016080:Arachnoid Cysts / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000209:etiology; D017029:Epilepsy, Complex Partial / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D019788:Fluorodeoxyglucose F18; D006222:Hamartoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007027:Hypothalamic Diseases / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18