title: Successful epilepsy surgery in frontal lobe epilepsy with startle seizures: a SEEG study.
abstract: Pre-surgical assessment and surgical management of frontal epilepsy with normal MRI is often challenging. We present a case of a 33-year-old, right-handed, educated male. During childhood, his seizures presented with mandibular myoclonus and no particular trigger. As a young adult, he developed seizures with a startle component, triggered by unexpected noises. During his ictal episodes, he felt fear and grimaced with sudden head flexion and tonic axial posturing. Similar seizures also occurred without startle. Neuropsychological assessment showed executive dysfunction and verbal memory deficit. The cerebral MRI was normal. Electro-clinical reasoning, investigations performed, the results obtained and follow-up are discussed in detail. [Published with video sequence].
authors.affiliation: Neurology, Neurovascular Diseases National Institute, Bucharest, Romania, Physics Department, University of Bucharest, Bucharest, Romania, Neurosurgery Department, Bagdasar-Arseni Hospital, Bucharest, Romania.
authors.forename: Ana
authors.initials: A
authors.lastname: Ciurea
authors.affiliation: Neurology Department, University Emergency Hospital, Bucharest, Romania.
authors.forename: Irina
authors.initials: I
authors.lastname: Popa
authors.affiliation: Neurology Department, University Emergency Hospital, Bucharest, Romania.
authors.forename: Mihai Dragos
authors.initials: MD
authors.lastname: Maliia
authors.affiliation: Neurology Department, University Emergency Hospital, Bucharest, Romania.
authors.forename: Nagy
authors.initials: N
authors.lastname: Csilla-Johanna
authors.affiliation: Physics Department, University of Bucharest, Bucharest, Romania, FHC Inc, Bowdoin ME, USA.
authors.forename: Andrei
authors.initials: A
authors.lastname: Barborica
authors.affiliation: Physics Department, University of Bucharest, Bucharest, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Donos
authors.affiliation: Neurosurgery Department, Bagdasar-Arseni Hospital, Bucharest, Romania.
authors.forename: Jean
authors.initials: J
authors.lastname: Ciurea
authors.affiliation: Department of Physiology & Pharmacology, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
authors.forename: Ioan
authors.initials: I
authors.lastname: Opris
authors.affiliation: Neurology Department, University Emergency Hospital, Bucharest, Romania, Neurology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Ioana
authors.initials: I
authors.lastname: Mindruta
mesh_terms: D000328:Adult; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000503:physiopathology / Q000601:surgery*; D005625:Frontal Lobe / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D013216:Reflex, Startle / Q000502:physiology*; D016896:Treatment Outcome
keywords: SEEG; focal cortical dysplasia; mesial fronto-parietal network; startle epilepsy