Department of Neurology, University of Michigan, Ann Arbor, Michigan 48109-5322, USA.
Pediatr Neurol. 2011 Aug;45(2):121-4. doi: 10.1016/j.pediatrneurol.2011.03.004.
The localizing value of experiential phenomena in temporal and occipital lobe epilepsy has become increasingly elucidated. We describe complex visual and auditory hallucinations in a right-handed adolescent and review the localization value of ictal visual and auditory auras in partial epilepsy. A 15-year-old right-handed girl with 2 previous secondarily generalized seizures manifested a new semiology of complex visual and auditory hallucinations, characterized by seeing a school bus full of children and then hearing a male voice tell her to "feed the children." Feeling compelled, she "fed" the children, and they reboarded the bus and the bus drove away. Video electroencephalogram monitoring demonstrated fluent language during her seizures. Magnetic resonance imaging was compatible with left mesial temporal sclerosis. Fluorodeoxyglucose positron emission tomography demonstrated left temporal hypometabolism. An ictal single-photon emission computed tomography study demonstrated left anterior temporal hyperperfusion; Wada testing revealed reversed cerebral dominance. The patient underwent left anterior temporal lobectomy without complication and remains seizure-free. Complex auditory and visual hallucinations can occur in occipitotemporal and anteromedial temporal epilepsy. Reversed cerebral dominance is more common in children than adults and should be considered in any dextral person with fluent ictal speech with a left-sided epileptogenic lesion.
经验性现象在颞叶和枕叶癫痫中的定位价值已逐渐阐明。我们描述了一名右利手青少年的复杂视觉和听觉幻觉，并回顾了部分癫痫发作中发作性视觉和听觉先兆的定位价值。一名 15 岁的右利手女孩，有 2 次继发性全身性癫痫发作，表现出新的复杂视觉和听觉幻觉，表现为看到一辆满载儿童的校车，然后听到一个男声告诉她“喂孩子”。她感到被迫，“喂”了孩子们，他们又上了公共汽车，公共汽车开走了。视频脑电图监测显示她在癫痫发作时语言流利。磁共振成像与左侧内侧颞叶硬化症相符。氟脱氧葡萄糖正电子发射断层扫描显示左侧颞叶代谢低下。发作期单光子发射计算机断层扫描研究显示左侧前颞叶高灌注；Wada 测试显示大脑优势反转。患者接受了左侧前颞叶切除术，无并发症，且无癫痫发作。复杂的听觉和视觉幻觉可发生在颞叶和前内侧颞叶癫痫中。大脑优势反转在儿童中比成人更常见，对于任何语言流利、左侧致痫病变的右利手患者，都应考虑这一点。
