EEG-fMRI findings in late seizure recurrence following temporal lobectomy: A possible contribution of area tempestas

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• 作者：Kyriakos Garganis ; Vasileios Kokkinos ; Basilios Zountsas
• 关键词：EEG&ndash ; fMRI ; Area tempestas ; Piriform cortex ; Mesial temporal sclerosis ; Epileptogenesis
• 刊名：Epilepsy & Behavior Case Reports
• 出版年：2013
• 年：2013
• 卷：1
• 期：Complete
• 页码：157-160
• 全文大小：858 K

文摘

Late seizure relapses following temporal lobectomy for drug-resistant temporal lobe epilepsy occur in 18-30% of operated-on cases, and recent evidence suggests that a significant proportion of them are due to maturation and activation of proepileptic tissue having defied initial resection and located at the vicinity of or at a short distance from its borders, usually over the posterior medial, basal temporal-occipital, and lateral temporal regions. Experimental studies in animals and functional imaging studies in humans suggest that the area tempestas, a particular region of the basal-frontal piriform cortex, is critical for kindling and initiation and propagation of seizure activity arising from different cortical foci, especially limbic ones. This case report of a patient with late seizure relapse, three years following an initially successful right temporal lobectomy for ipsilateral medial temporal sclerosis, is the first one in the literature to demonstrate interictal EEG-fMRI evidence of significant BOLD signal changes over the inferior, basal and lateral temporal and temporooccipital cortices posterior to the resection margin, plus a significant BOLD signal change over the ipsilateral basal frontal region, closely corresponding to the piriform cortex/area tempestas. Our case study provides further functional imaging evidence in support of maturation/activation of proepileptic tissue located at the vicinity of the initial temporal lobe resection in cases of late seizure relapses and suggests, in addition, a possible role for the piriform cortex/area tempestas in the relapsing process.