Nakamura Tomohiro, Hatano Keisuke, Sato Keishiro, Enoki Hideo, Fujimoto Ayataka
Department of Neurosurgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan.
Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan.
Heliyon. 2023 Jul 13;9(7):e18237. doi: 10.1016/j.heliyon.2023.e18237. eCollection 2023 Jul.
Several cases of temporal lobe epilepsy (TLE) showing false lateralization of ictal scalp electroencephalography (EEG) have been reported. However, TLE with cavernous malformation indicating false lateralization of both ictal scalp EEG and semiology as in the present case is rare. The aim of this report is to call attention to avoiding overestimation of ictal scalp EEG findings in epilepsy patients with cavernous malformation.
A 25-year-old man without any medical history suffered from seizures for a year despite appropriate anti-epileptic medication. Magnetic resonance imaging (MRI) revealed cavernous malformation in the left amygdala. The seizure type was brief impaired consciousness with left dystonic posturing, preceded by a sensation of blood rushing to the head. Long-term video EEG with scalp electrodes showed periodic sharp waves beginning from the right temporal area during seizures. Although both semiology and ictal scalp EEG indicated right TLE, intracranial EEG revealed the onset of low-voltage fast activity from the left hippocampus near the cavernous malformation. This patient therefore underwent removal of cavernous malformation and left amygdala, and achieved freedom from seizures postoperatively.
We reinforce the importance of performing intracranial EEG for cavernous malformation-associated epilepsy when discrepancies between scalp EEG and MRI are evident.
已有数例颞叶癫痫（TLE）患者发作期头皮脑电图（EEG）出现假定位的报道。然而，如本例所示，伴有海绵状畸形且发作期头皮EEG和症状学均出现假定位的TLE较为罕见。本报告旨在提醒注意避免对患有海绵状畸形的癫痫患者的发作期头皮EEG结果估计过高。
一名25岁无任何病史的男性，尽管接受了适当的抗癫痫药物治疗，但仍有一年的癫痫发作史。磁共振成像（MRI）显示左侧杏仁核有海绵状畸形。发作类型为短暂意识障碍伴左侧张力障碍姿势，发作前有头部充血感。头皮电极长程视频EEG显示发作期间从右侧颞区开始出现周期性尖波。尽管症状学和发作期头皮EEG均提示右侧TLE，但颅内EEG显示海绵状畸形附近左侧海马区出现低电压快速活动起始。因此，该患者接受了海绵状畸形和左侧杏仁核切除术，术后癫痫发作消失。
当头皮EEG与MRI之间存在明显差异时，我们强调对海绵状畸形相关性癫痫进行颅内EEG检查的重要性。
