Ginevra Michael, Archer John, Bulluss Kristian, Tailby Chris, Jackson Graeme D, Vaughan David N
Department of Neurology, Austin Health, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Epileptic Disord. 2025 Jun;27(3):457-463. doi: 10.1002/epd2.70027. Epub 2025 Apr 8.
A 22-year-old female presented with drug-resistant focal motor seizures with onset at age 14. This manifested as daily episodes of right facial dystonia triggered by toothbrushing, but also by eating, talking, and strenuous exercise. On ictal scalp EEG, there was low-voltage fast activity over the left pericentral area. Structural MRI did not identify a definite lesion. Functional MRI (fMRI) of a reflex seizure, as well as task-based fMRI during toothbrushing, both demonstrated focal activation at the left low pericentral cortex. Stereoelectroencephalography (sEEG) showed recurrent ictal trains of focal spiking concordant with the fMRI activation. Radiofrequency (RF) thermocoagulation was applied at the posterior bank of the left low pre-central gyrus, with post-operative MRI confirming small ablative lesions immediately deep to the ictal fMRI activation, and the patient remains seizure-free more than 3 years after this treatment. Toothbrushing epilepsy is a rare form of reflex epilepsy where seizures are induced by toothbrushing. In this unique case, ictal fMRI assisted targeting of the sEEG implantation, to confirm seizure onset and enable minimally invasive treatment via RF thermocoagulation, resulting in seizure freedom.
一名22岁女性，14岁起出现耐药性局灶性运动性癫痫发作。表现为每日发作的右侧面部肌张力障碍，刷牙可诱发，进食、说话及剧烈运动也可诱发。发作期头皮脑电图显示左侧中央旁区有低电压快速活动。结构磁共振成像未发现明确病变。反射性癫痫的功能磁共振成像以及刷牙时基于任务的功能磁共振成像均显示左侧中央旁下回皮质有局灶性激活。立体脑电图显示反复出现的局灶性棘波发作序列，与功能磁共振成像激活情况一致。在左侧中央前回下部后缘进行了射频热凝治疗，术后磁共振成像证实热凝造成的小消融灶紧邻发作期功能磁共振成像激活区深部，患者在该治疗后3年多无癫痫发作。刷牙性癫痫是一种罕见的反射性癫痫，由刷牙诱发癫痫发作。在这个独特病例中，发作期功能磁共振成像辅助立体脑电图植入定位，以确定癫痫发作起始点，并通过射频热凝实现微创治疗，从而实现无癫痫发作。
