A Surgical Case of Frontal Lobe Epilepsy Due to Focal Cortical Dysplasia Accompanied by Olfactory Nerve Enlargement: Case Report

Abstract BACKGROUND: Epilepsy surgery for magnetic resonance imaging (MRI)-negative patients has a less favorable outcome. OBJECTIVE: Detection of subclinical abnormal gyration (SAG) patterns and their potential contribution to assessment of the topography of the epileptogenic zone (EZ) is addressed in MRI-negative patients with frontal lobe epilepsy. METHODS: Between September 1998 and July 2005, 12 MRI-negative frontal lobe epilepsy patients underwent stereoelectroencephalography with postcorticectomy follow-up of longer than 1 year (average, 3.3 years). Original software (BrainVISA/Anatomist, http://brainvisa.info) trained on a database of normal volunteers was used to determine which sulci had morphology out of the normal range (SAG). Topography of the EZ, SAG pattern, corticectomy, postoperative seizure control, and histopathology were analyzed. RESULTS: At last follow-up, 8 of 12 patients (66.7%) were Engel class I (7 IA and 1 IB), 2 class II, and 2 class IV. Small focal cortical dysplasia was histologically diagnosed in 9 of the 12 patients (75%), including 7 of 8 seizure-free patients (87.5%). A SAG pattern was found to be in the EZ area in 9 patients (75%), in the ipsilateral frontal lobe out of the EZ in 2, and limited to the contralateral hemisphere in 1. CONCLUSION: SAG patterns appear to be associated with the topography of the EZ in MRI-negative frontal lobe epilepsy and may have a useful role in preoperative assessment. Small focal cortical dysplasia not detected with MRI is often found on histopathological examination, particularly in the depth of the posterior part of the superior frontal sulcus and intermediate frontal sulcus, suggesting a specific developmental critical zone in these locations.

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Novel pathological abnormalities of deep brain structures including dysplastic neurons in anterior striatum associated with focal cortical dysplasia in epilepsy

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.6.peds11325 ◽

2012 ◽

Vol 10 (3) ◽

pp. 217-225 ◽

Cited By ~ 8

Author(s):

Takanobu Kaido ◽

Taisuke Otsuki ◽

Akiyoshi Kakita ◽

Kenji Sugai ◽

Yoshiaki Saito ◽

...

Keyword(s):

White Matter ◽

Frontal Lobe ◽

Focal Cortical Dysplasia ◽

Brain Structures ◽

Cortical Dysplasia ◽

Frontal Lobe Epilepsy ◽

Periventricular White Matter ◽

Dysmorphic Neurons ◽

Dysplastic Neurons ◽

Deep Brain

Object Some patients are not seizure free even after epileptogenic cortical resection. The authors recently described a case of frontal lobe epilepsy cured after the resection of periventricular white matter and striatum, in which dysplastic neurons were revealed. The authors attempted to confirm similar cases. Methods They reviewed the records of 8 children with frontal lobe epilepsy who had daily (7) or monthly (1) seizures and underwent resections including deep brain structures. Results Five patients underwent multiple resections. Neuroimaging of the deep structures showed the transmantle sign in 3 patients, ictal hyperperfusion in 6, reduced iomazenil uptake in 2, and spike dipole clustering in 6. All patients became seizure free postoperatively. Focal cortical dysplasia of various types was diagnosed in all patients. Dysmorphic neurons were found in the cortex and subcortical white matter of 5 patients. The striatum was verified in 3 patients in whom dysmorphic neurons were scattered. In the periventricular white matter, prominent astrocytosis was evident in all cases. Conclusions Pathological abnormalities such as dysmorphic neurons and astrocytosis in deep brain structures would play a key role in epileptogenesis.

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Ictal Forced Repetitive Swearing in Frontal Lobe Epilepsy: Case report and review of the literature

Journal of Epileptology ◽

10.1515/joepi-2015-0019 ◽

2014 ◽

Vol 22 (2) ◽

pp. 113-119 ◽

Cited By ~ 2

Author(s):

Marjan Dolatshahi ◽

Alexei Yankovsky

Keyword(s):

Case Report ◽

Frontal Lobe ◽

Focal Cortical Dysplasia ◽

Epileptic Focus ◽

Frontal Lobe Epilepsy ◽

Seizure Freedom ◽

Hypermotor Seizures ◽

Eeg Recordings ◽

The Right ◽

Video Eeg

SUMMARYIntroduction.Dominant presentation of ictal forced repetitive swearing has been rarely addressed and could be misdiagnosed.Case report.We report a 45-year-old man with a long history of right frontal lobe epilepsy (FLE) who developed forced repetitive swearing during hypermotor seizures. His seizures were refractory to different antiepileptic drugs (AEDs). Scalp video-EEG telemetry suggested a right frontal epileptic focus. Magnetic resonance imaging (MRI) suggested focal cortical dysplasia (FCD) in the right mesial frontal lobe. Intracranial implantation with video-EEG recordings confirmed seizures originating from the MRI lesion. Patient underwent right frontal lobe resection followed by seizure freedom in the last five years on a single AED. Neuropathology confirmed FCD type IIB.Discussion.The following aspects of the case are discussed: FLE and ictal vocalization, swearing, FLE and aggression. We emphasize the differences among ictal vocalisation, verbal automatism and ictal speech. We propose that ictal swearing might fit a verbal automatism definition.Conclusion.Ictal forced repetitive swearing can be a manifestation of hypermotor seizures in FLE and should not be misdiagnosed.

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