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Ictal singing due to right mesial temporal lobe epilepsy involving a bihemispheric network.

Lee EM, Kang JK, Park GY, Oh JS, Kim JS - Epilepsy Behav Case Rep (2013)

Bottom Line: Singing is a rare ictal symptom of focal epilepsy.Subtraction ictal SPECT coregistered to MRI (SISCOM) performed during ictal singing demonstrated areas of hyperperfusion in the bilateral frontal regions (more prominent in the left frontal lobe), bilateral subcortical regions, insular cortices, and bilateral cerebellum in addition to the right temporal area.These findings suggest that the symptomatogenic zone for ictal singing includes neural networks from the frontal and temporal regions of both hemispheres rather than specific cortical areas even when the epileptogenic zone is located in the right mesial temporal area, as evidenced in this patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.

ABSTRACT
Singing is a rare ictal symptom of focal epilepsy. Here, we report a case of a right-handed patient who demonstrated ictal singing due to right mesial temporal lobe epilepsy. Subtraction ictal SPECT coregistered to MRI (SISCOM) performed during ictal singing demonstrated areas of hyperperfusion in the bilateral frontal regions (more prominent in the left frontal lobe), bilateral subcortical regions, insular cortices, and bilateral cerebellum in addition to the right temporal area. An intracranial EEG revealed that an ictal singing episode commenced after an ictal rhythm from the right temporal area was propagated to the contralateral side of the left hemisphere. These findings suggest that the symptomatogenic zone for ictal singing includes neural networks from the frontal and temporal regions of both hemispheres rather than specific cortical areas even when the epileptogenic zone is located in the right mesial temporal area, as evidenced in this patient.

No MeSH data available.


Related in: MedlinePlus

(A) Oblique coronal T2-weighted magnetic resonance imaging showing mesial temporal sclerosis in the right hippocampus. (B) FDG-PET, compared to normal age-matched control, showing decreased metabolism in the right medial, lateral temporal, left lateral temporal, and both frontal cortices. (C) SISCOM showing hyperperfusion in the right temporal lobe, bilateral frontal lobe (more prominent hyperperfusion is noted in the left frontal lobe), bilateral basal ganglia, insular cortex, and bilateral cerebellum.
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f0005: (A) Oblique coronal T2-weighted magnetic resonance imaging showing mesial temporal sclerosis in the right hippocampus. (B) FDG-PET, compared to normal age-matched control, showing decreased metabolism in the right medial, lateral temporal, left lateral temporal, and both frontal cortices. (C) SISCOM showing hyperperfusion in the right temporal lobe, bilateral frontal lobe (more prominent hyperperfusion is noted in the left frontal lobe), bilateral basal ganglia, insular cortex, and bilateral cerebellum.

Mentions: A 40-year-old right-handed man was evaluated to assess his 3-year history of drug-resistant epilepsy. His seizures began with an epigastric aura followed by singing and occasional lip smacking and secondary generalizations. His medications included 1000 mg of levetiracetam per day and 300 mg of zonisamide per day, but he still experienced habitual seizures once per week. He had no history of febrile convulsions, CNS infection, trauma, or perinatal complications, and his family history was unremarkable. In addition, the patient had had no formal musical training. The patient's neurological examination was unremarkable. A brain MRI indicated right hippocampal atrophy (Fig. 1A). Fluorodeoxyglucose positron-emission tomography (FDG-PET), compared to healthy age-matched control, demonstrated decreased metabolism in the right medial, lateral temporal, left lateral temporal, and both frontal cortices (Fig. 1B).


Ictal singing due to right mesial temporal lobe epilepsy involving a bihemispheric network.

Lee EM, Kang JK, Park GY, Oh JS, Kim JS - Epilepsy Behav Case Rep (2013)

(A) Oblique coronal T2-weighted magnetic resonance imaging showing mesial temporal sclerosis in the right hippocampus. (B) FDG-PET, compared to normal age-matched control, showing decreased metabolism in the right medial, lateral temporal, left lateral temporal, and both frontal cortices. (C) SISCOM showing hyperperfusion in the right temporal lobe, bilateral frontal lobe (more prominent hyperperfusion is noted in the left frontal lobe), bilateral basal ganglia, insular cortex, and bilateral cerebellum.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150646&req=5

f0005: (A) Oblique coronal T2-weighted magnetic resonance imaging showing mesial temporal sclerosis in the right hippocampus. (B) FDG-PET, compared to normal age-matched control, showing decreased metabolism in the right medial, lateral temporal, left lateral temporal, and both frontal cortices. (C) SISCOM showing hyperperfusion in the right temporal lobe, bilateral frontal lobe (more prominent hyperperfusion is noted in the left frontal lobe), bilateral basal ganglia, insular cortex, and bilateral cerebellum.
Mentions: A 40-year-old right-handed man was evaluated to assess his 3-year history of drug-resistant epilepsy. His seizures began with an epigastric aura followed by singing and occasional lip smacking and secondary generalizations. His medications included 1000 mg of levetiracetam per day and 300 mg of zonisamide per day, but he still experienced habitual seizures once per week. He had no history of febrile convulsions, CNS infection, trauma, or perinatal complications, and his family history was unremarkable. In addition, the patient had had no formal musical training. The patient's neurological examination was unremarkable. A brain MRI indicated right hippocampal atrophy (Fig. 1A). Fluorodeoxyglucose positron-emission tomography (FDG-PET), compared to healthy age-matched control, demonstrated decreased metabolism in the right medial, lateral temporal, left lateral temporal, and both frontal cortices (Fig. 1B).

Bottom Line: Singing is a rare ictal symptom of focal epilepsy.Subtraction ictal SPECT coregistered to MRI (SISCOM) performed during ictal singing demonstrated areas of hyperperfusion in the bilateral frontal regions (more prominent in the left frontal lobe), bilateral subcortical regions, insular cortices, and bilateral cerebellum in addition to the right temporal area.These findings suggest that the symptomatogenic zone for ictal singing includes neural networks from the frontal and temporal regions of both hemispheres rather than specific cortical areas even when the epileptogenic zone is located in the right mesial temporal area, as evidenced in this patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea.

ABSTRACT
Singing is a rare ictal symptom of focal epilepsy. Here, we report a case of a right-handed patient who demonstrated ictal singing due to right mesial temporal lobe epilepsy. Subtraction ictal SPECT coregistered to MRI (SISCOM) performed during ictal singing demonstrated areas of hyperperfusion in the bilateral frontal regions (more prominent in the left frontal lobe), bilateral subcortical regions, insular cortices, and bilateral cerebellum in addition to the right temporal area. An intracranial EEG revealed that an ictal singing episode commenced after an ictal rhythm from the right temporal area was propagated to the contralateral side of the left hemisphere. These findings suggest that the symptomatogenic zone for ictal singing includes neural networks from the frontal and temporal regions of both hemispheres rather than specific cortical areas even when the epileptogenic zone is located in the right mesial temporal area, as evidenced in this patient.

No MeSH data available.


Related in: MedlinePlus