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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

Scalp ictal EEG. Ictal injection during ictal SPECT was performed during ictal singing and 10 s before the singing episode finished. However, ictal EEG demonstrated muscle artifacts and nonlateralization.
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f0010: Scalp ictal EEG. Ictal injection during ictal SPECT was performed during ictal singing and 10 s before the singing episode finished. However, ictal EEG demonstrated muscle artifacts and nonlateralization.

Mentions: Video-EEG monitoring was performed using a 10–20 international system with sphenoidal electrodes. Interictal EEG demonstrated intermittent regional sharp waves in both temporal areas, which were more frequently observed on the right side (SP2). Ictal scalp EEG demonstrated brief, rhythmic, nonlateralized medium-amplitude theta activity in both temporal areas or occasional build-up in the left temporal area (Fig. 2) depending on the ictal events though the seizure semiology was usually the same for every event. Seizure semiology was characterized by singing and rhythmic slapping of the hands and legs while singing, which were sometimes followed by lip smacking and unresponsiveness. During ictal onset, the patient always sang the same Korean folk song that definitely comprised words, sentences, and melodies and usually lasted for about 20–30 s. Neither his mood nor the surrounding events could influence these spells, nor could he voluntarily stop or change the song. No convulsions or secondary generalizations were observed.


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)

Scalp ictal EEG. Ictal injection during ictal SPECT was performed during ictal singing and 10 s before the singing episode finished. However, ictal EEG demonstrated muscle artifacts and nonlateralization.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

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

f0010: Scalp ictal EEG. Ictal injection during ictal SPECT was performed during ictal singing and 10 s before the singing episode finished. However, ictal EEG demonstrated muscle artifacts and nonlateralization.
Mentions: Video-EEG monitoring was performed using a 10–20 international system with sphenoidal electrodes. Interictal EEG demonstrated intermittent regional sharp waves in both temporal areas, which were more frequently observed on the right side (SP2). Ictal scalp EEG demonstrated brief, rhythmic, nonlateralized medium-amplitude theta activity in both temporal areas or occasional build-up in the left temporal area (Fig. 2) depending on the ictal events though the seizure semiology was usually the same for every event. Seizure semiology was characterized by singing and rhythmic slapping of the hands and legs while singing, which were sometimes followed by lip smacking and unresponsiveness. During ictal onset, the patient always sang the same Korean folk song that definitely comprised words, sentences, and melodies and usually lasted for about 20–30 s. Neither his mood nor the surrounding events could influence these spells, nor could he voluntarily stop or change the song. No convulsions or secondary generalizations were observed.

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