Dobesberger Judith, Ortler Martin, Unterberger Iris, Walser Gerald, Falkenstetter Tina, Bodner Thomas, Benke Thomas, Bale Reto, Fiegele Thomas, Donnemiller Eveline, Gotwald Thaddaeus, Trinka Eugen
Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Epilepsia. 2008 Jan;49(1):159-62. doi: 10.1111/j.1528-1167.2007.01426.x. Epub 2007 Nov 19.
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.
夜间运动性癫痫发作（NHSs）提示癫痫发作起源于额叶。我们报告了一名患有NHSs且发作起源于岛叶的患者，该患者接受了成功的手术治疗。一名29岁右利手男性自12岁起就患有难治性NHSs。高分辨率MRI、[（18）F]FDG-PET和神经心理学检查结果均正常，发作期脑电图被伪迹掩盖。发作期[（99m）Tc]HMPAO-SPECT显示岛叶右前部和右侧额盖有血流灌注增加。根据侵入性记录，癫痫发作起始区定位于右侧前岛叶。该区域的电刺激引发习惯性癫痫发作。对右侧岛叶前部和右侧额盖进行了有限切除，使患者无癫痫发作（随访1年）。据我们所知，这是首例报道的发作起源于岛叶且患有NHSs的非病变患者接受成功癫痫手术的病例。
