title: Acquired epileptiform opercular syndrome: F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) findings and efficacy of levetiracetam therapy.
abstract: We report a five-year-old girl presenting with dysphagia, dysarthria, drooling, and generalized tonic convulsions in whom the final diagnosis was acquired epileptiform opercular syndrome. Levetiracetam monotherapy at a dosage of 40 mg/kg/day improved the clinical findings, and seizures were controlled at the end of the first month of treatment. Six months after the initial diagnosis, she presented with speech deterioration and dysarthria. At this time, although sleep and awake electroencephalography (EEG) were normal, FDG-PET showed hypometabolic and hypermetabolic regions in the anterior/inferior and anterior regions of the right frontal lobe, respectively. By increasing before levetiracetam dosage to 50 mg/kg/day, the clinical findings resolved and the patient is still seizure free. Acquired epileptiform opercular syndrome is a rare epileptic disorder in which the seizures are resistant to conventional antiepileptic drugs. Levetiracetam may be an effective antiepileptic drug in controlling seizures and other clinical findings in acquired opercular epileptiform syndrome. Hypometabolic and hypermetabolic regions in FDG-PET study may be due to ongoing seizure activity or impaired glucose metabolism in this disorder.
authors.affiliation: Gülhane Military Medical School, Department of Pediatrics, Division of Child Neurology, Etlik, Ankara, Turkey. mutluayarslan@yahoo.com
authors.forename: Mutluay
authors.initials: M
authors.lastname: Arslan
authors.forename: Uluç
authors.initials: U
authors.lastname: Yiş
authors.forename: Sebahattin
authors.initials: S
authors.lastname: Vurucu
authors.forename: Semra
authors.initials: S
authors.lastname: Ince
authors.forename: Bülent
authors.initials: B
authors.lastname: Ünay
authors.forename: Rıdvan
authors.initials: R
authors.lastname: Akın
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D004401:Dysarthria / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D000077287:Levetiracetam; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D049268:Positron-Emission Tomography; D012798:Sialorrhea / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D000927:Anticonvulsants; D019788:Fluorodeoxyglucose F18; D000077287:Levetiracetam; D010889:Piracetam