title: Ictal fear auras after selective amygdalohippocampectomy: the use of ictal SPECT and scalp EEG in the presurgical reevaluation.
abstract: The perception of fear aura in complex partial seizures is linked to epileptic discharges within mesial temporal lobe structures. Although selective amygdalohippocampectomy often leads to favorable seizure control, persistence of fear auras after surgery can hamper quality of life significantly. We describe two patients with persistent fear auras after selective amygdalohippocampectomy who had to be reevaluated for a second operative procedure. In one patient, ictal SPECT revealed focal hyperperfusion within the left temporal pole. In the other patient, localization of the focus was possible with ictal scalp EEG, which revealed closely time-related focal theta activity in the right frontotemporal electrodes. Both patients underwent a second surgery leading to complete remission. The persistence of fear auras after selective amygdalohippocampectomy provides an example of involvement of a complex neuronal network in the generation of this emotional state during mesiotemporal lobe seizures. Ictal SPECT or ictal scalp EEG may be valuable in identifying the involved areas and in guiding the surgeon to render these patients seizure free.
authors: Division of Neurology, Medical University of Graz, Graz, Austria. tadeja.urbanic-purkart@medunigraz.at
authors: Purkart Tadeja
authors: PT
authors: Urbanic
authors: Karla
authors: K
authors: Zaar
authors: Hans
authors: H
authors: Eder
authors: Lucia
authors: L
authors: Gruber-Cichocky
authors: Michael
authors: M
authors: Feichtinger
mesh_terms: D000328:Adult; D000679:Amygdala / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D004569:Electroencephalography; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005239:Fear; D005260:Female; D006624:Hippocampus / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D011859:Radiography; D012535:Scalp; D015899:Tomography, Emission-Computed, Single-Photon