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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) Hippocampal depth electrodes were inserted into occipital burr holes in the occipitotemporal direction, and subdural electrodes were placed through temporal burr holes in order to cover the temporal lobe. (B) Intracranial ictal EEG demonstrating preictal discharge in the right hippocampal depth electrodes, followed by fast low-amplitude activity in the right hippocampal depth electrodes that later propagated to the left hemisphere. Singing was observed several seconds after the ictal rhythm propagated to the left hemisphere.
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f0015: (A) Hippocampal depth electrodes were inserted into occipital burr holes in the occipitotemporal direction, and subdural electrodes were placed through temporal burr holes in order to cover the temporal lobe. (B) Intracranial ictal EEG demonstrating preictal discharge in the right hippocampal depth electrodes, followed by fast low-amplitude activity in the right hippocampal depth electrodes that later propagated to the left hemisphere. Singing was observed several seconds after the ictal rhythm propagated to the left hemisphere.

Mentions: Subtraction ictal SPECT coregistered to MRI (SISCOM) revealed areas of hyperperfusion in the right temporal lobe, bilateral frontal lobes (more prominent hyperperfusion was noted in the left frontal lobe), bilateral basal ganglia, insular cortex, and bilateral cerebellum (Fig. 1C). Wada test revealed language dominance in the left hemisphere. Because of discrepancies and uncertainties with regard to the lateralization of the ictal scalp EEG, an intracranial evaluation was performed using bilateral hippocampal depth electrodes (8 contacts per electrode; Ad-Tech Medical Instrument Corp.) and subdural temporal strips (4 disk contacts per strip; Ad-Tech Medical Instrument Corp.). The hippocampal depth electrodes were inserted into occipital burr holes in the occipitotemporal direction, and the subdural electrodes were placed through temporal burr holes in order to cover the temporal areas (Fig. 3A). Three strip electrodes were anterolaterally, mesially, and posterolaterally placed over the temporal lobe in each side.


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) Hippocampal depth electrodes were inserted into occipital burr holes in the occipitotemporal direction, and subdural electrodes were placed through temporal burr holes in order to cover the temporal lobe. (B) Intracranial ictal EEG demonstrating preictal discharge in the right hippocampal depth electrodes, followed by fast low-amplitude activity in the right hippocampal depth electrodes that later propagated to the left hemisphere. Singing was observed several seconds after the ictal rhythm propagated to the left hemisphere.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

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

f0015: (A) Hippocampal depth electrodes were inserted into occipital burr holes in the occipitotemporal direction, and subdural electrodes were placed through temporal burr holes in order to cover the temporal lobe. (B) Intracranial ictal EEG demonstrating preictal discharge in the right hippocampal depth electrodes, followed by fast low-amplitude activity in the right hippocampal depth electrodes that later propagated to the left hemisphere. Singing was observed several seconds after the ictal rhythm propagated to the left hemisphere.
Mentions: Subtraction ictal SPECT coregistered to MRI (SISCOM) revealed areas of hyperperfusion in the right temporal lobe, bilateral frontal lobes (more prominent hyperperfusion was noted in the left frontal lobe), bilateral basal ganglia, insular cortex, and bilateral cerebellum (Fig. 1C). Wada test revealed language dominance in the left hemisphere. Because of discrepancies and uncertainties with regard to the lateralization of the ictal scalp EEG, an intracranial evaluation was performed using bilateral hippocampal depth electrodes (8 contacts per electrode; Ad-Tech Medical Instrument Corp.) and subdural temporal strips (4 disk contacts per strip; Ad-Tech Medical Instrument Corp.). The hippocampal depth electrodes were inserted into occipital burr holes in the occipitotemporal direction, and the subdural electrodes were placed through temporal burr holes in order to cover the temporal areas (Fig. 3A). Three strip electrodes were anterolaterally, mesially, and posterolaterally placed over the temporal lobe in each side.

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