Montreal Neurological Institute and Hospital, McGill University, Montréal, Canada, Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
Montreal Neurological Institute and Hospital, McGill University, Montréal, Canada.
Epileptic Disord. 2020 Dec 1;22(6):797-801. doi: 10.1684/epd.2020.1225.
We present a rare patient clinically suspected to have mixed idiopathic generalized and focal epilepsy, which was supported by BOLD pattern based on EEG-fMRI. A 37-year-old female with three types of refractory seizures starting at age six - tonic with breathing difficulties and confusion, generalized tonic-clonic, and focal with brief impairment of awareness and versive head movement, initially thought to represent atypical absences - was evaluated by EEG-fMRI. She was also shown to have three types of interictal epileptic discharges: generalized spike or polyspikes and slow waves, and left fronto-temporal and right fronto-temporal discharges. We assessed BOLD activation and deactivation for each type. For generalized patterns, the BOLD activation and deactivation were typical of that seen in primary generalized epilepsy. Whereas maximum activation for left fronto-temporal EEG patterns was observed in the left superior frontal gyrus and posterior superior temporal gyrus, maximum activation for right fronto-temporal patterns was bilateral in the right posterior middle temporal gyrus and left posterior middle temporal gyrus. The EEG-fMRI results suggested that the patient had both refractory idiopathic generalized and focal epilepsy, and not a generalized epilepsy originating from a focus.
我们呈现了一位临床上疑似混合特发性全面性和局灶性癫痫的罕见患者，该病例基于 EEG-fMRI 的 BOLD 模式得到支持。一位 37 岁女性，自 6 岁起出现三种类型的难治性癫痫发作——伴有呼吸困难和意识模糊的强直发作、全面强直阵挛发作和伴有短暂意识障碍和偏头运动的局灶性发作，最初被认为是不典型失神发作——接受了 EEG-fMRI 评估。她还表现出三种类型的发作间期癫痫放电：全面性棘波或多棘波和慢波，以及左额颞部和右额颞部放电。我们评估了每种类型的 BOLD 激活和失活。对于全面性模式，BOLD 激活和失活与原发性全面性癫痫所见的典型模式一致。而对于左额颞部 EEG 模式，最大激活位于左额上回和后上颞回；对于右额颞部模式，最大激活则是双侧的，位于右中颞回和左中颞回。EEG-fMRI 结果提示该患者患有难治性特发性全面性和局灶性癫痫，而不是起源于病灶的全面性癫痫。
