Rare cases of reflex epilepsy in patients with gliomas of the left hemisphere.

We present the cases of symptomatic reflex epilepsy in patients with left hemisphere tumors. The first case: a 23-year-old man has had tonic-clonic seizures of the tongue with rare secondary localization over the past several months. The seizures were caused by intense tongue movements, in particular rightward and leftward (when having chewing gum or a candy in his mouth), but not during speech production or eating. MRI scanning detected a small tumor in the lower segments of the central gyrus. It was found during the surgery under electrophysiological control that the tumor (Gr II astrocytoma) resided in the zone corresponding to the right half of the tongue and included this zone. The tumor was partially resected. The second patient, a 52-year-old man, has been suffering from generalized seizures since 1998. The seizures were caused by intense verbal load, in the beginning of spontaneous speech and subsequently when the patient was listening to others' speech or was writing. Spontaneous seizures emerged when the patient stopped taking his anti-seizure medications unilaterally. MRI showed glioma in the posterior segments of the left temporal lobe. The patient underwent radiation and chemotherapy. In 2013, the patient's condition worsened (right-sided hemiparesis and severe speech impairment emerged); the tumor was partially resected and an extensive cyst was opened. The third patient, a 38-year-old man with Gr III astrocytoma in the left insula with past medical history of spontaneous vegetative seizures, had only a seizure anticipation caused by strong smells. All the patients were prescribed chemo-, radiation, and anti-seizure therapy.