听觉性言语幻觉作为耐药性癫痫患者的发作期现象

Perez Juan Toro, Burneo Jorge G, Macdougall Keith, McLachlan Richard, Mirsattari Seyed M, Diosy David C, Hayman-Abello Brent, Aluwari Mubarak, Herrera Manuel, Arevalo Miguel, Suller Marti Ana

Clinical Neurological Science Department, University Hospital - Western University, London, Ontario, Canada; Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario-University of Ottawa, Ottawa, Ontario, Canada.

Clinical Neurological Science Department, University Hospital - Western University, London, Ontario, Canada; Neuroepidemiology Unit, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

Clin Neurol Neurosurg. 2022 May;216:107223. doi: 10.1016/j.clineuro.2022.107223. Epub 2022 Mar 26.

PURPOSE

The presence of verbal auditory hallucinations is often associated with psychotic disorders and rarely is considered as an ictal phenomena. The aim of this paper is to describe the anatomical structures involved in the genesis of this ictal symptom during epileptic seizures and direct cortical stimulation using stereo encephalography (SEEG).

METHOD

The case is of a 31-year-old right-handed female, bilateral speech representation, schizophrenia and with drug-resistant epilepsy and focal aware sensory seizures characterized by ictal verbal auditory hallucinations. She was implanted with depth electrodes, and she was monitored using SEEG recordings.

RESULTS

She had focal aware sensory seizures characterized by verbal auditory hallucinations, with the following features: hearing numerous voices (both male and/or female), talking at the same time (not able to distinguish how many). The voices were inside her head, consisted of negative content, and lasted up to two minutes. Some of her focal aware sensory seizures evolved to focal motor seizures and rarely progressed to bilateral tonic clonic seizures. Her neurological examination, her brain MRI and her interictal SPECT were unremarkable. Her PET scan identified mild hypo metabolism over the right temporal and right frontal lobes. Her neuropsychological evaluation showed language laterality undetermined but her functional MRI showed bilateral language representation. On her video-EEG, three seizures were captured with a right posterior temporal onset. A subsequent SEEG showed thirteen typical seizures originating from the posterior temporal neocortical region. The cortical stimulation of the right posterior temporo-parietal neocortical region and right amygdala triggered her typical phenomena, which was multiple voices, inside her head, speaking in the second person, negative content, unable to identify gender, in English, and no side lateralization.

CONCLUSION

Verbal auditory hallucinations should be analyzed carefully because they can be part of the seizure presentation. Our case supports the localization of these hallucinations in the right posterior neocortical temporal regions.

目的

言语性幻听的存在通常与精神障碍相关，很少被视为发作期现象。本文旨在描述癫痫发作和立体定向脑电图（SEEG）引导下直接皮质刺激期间，这种发作期症状产生所涉及的解剖结构。

方法

该病例为一名31岁右利手女性，双侧语言代表区，患有精神分裂症、耐药性癫痫，以及以发作期言语性幻听为特征的局灶性觉知感觉性发作。她被植入了深度电极，并使用SEEG记录进行监测。

结果

她有以言语性幻听为特征的局灶性觉知感觉性发作，具有以下特点：听到众多声音（男性和/或女性），同时说话（无法分辨有多少）。声音在她脑海中，内容消极，持续长达两分钟。她的一些局灶性觉知感觉性发作演变为局灶性运动性发作，很少进展为双侧强直阵挛性发作。她的神经系统检查、脑部MRI和发作间期SPECT均无异常。她的PET扫描显示右侧颞叶和右侧额叶轻度代谢减低。她的神经心理学评估显示语言优势半球未确定，但功能MRI显示双侧语言代表区。在她的视频脑电图上，捕捉到3次发作，起始于右侧颞后部。随后的SEEG显示13次典型发作起源于颞后新皮质区。右侧颞顶叶新皮质区和右侧杏仁核的皮质刺激引发了她的典型现象，即脑海中有多个声音，以第二人称说话，内容消极，无法辨别性别，用英语表述，且无侧别定位。