Successful surgical treatment of insular epilepsy with nocturnal hypermotor seizures.
Nocturnal hypermotor seizures (NHSs) suggest seizure onset in the frontal lobe. We present a patient with NHSs and insular seizure onset who underwent successful surgical treatment. A 29-year-old right-handed man suffered from intractable NHSs since the age of 12 years. High-resolution MRI, [(18)F]FDG-PET, and neuropsychological examination gave normal results, ictal EEG was obscured by artifacts. Ictal [(99m)Tc]HMPAO-SPECT revealed hyperperfusion in the right anterior part of the insula and right frontal operculum. The seizure onset zone was localized in the right anterior insula based on invasive recordings. Electrical stimulation in that area elicited habitual seizures. A limited resection of the anterior part of the right insula and the right frontal operculum was performed rendering the patient seizure-free (follow-up 1 year). To our knowledge, this is the first reported nonlesional patient with an insular seizure onset and NHSs who underwent successful epilepsy surgery.
Dobesberger
Judith
J
Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Ortler
Martin
M
Unterberger
Iris
I
Walser
Gerald
G
Falkenstetter
Tina
T
Bodner
Thomas
T
Benke
Thomas
T
Bale
Reto
R
Fiegele
Thomas
T
Donnemiller
Eveline
E
Gotwald
Thaddaeus
T
Trinka
Eugen
E
D000328:Adult; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000601:surgery*; D018572:Disease-Free Survival; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000706:statistics & numerical data; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000000981:diagnostic imaging; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D012640:Seizures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data; D016896:Treatment Outcome
D019690:Technetium Tc 99m Exametazime