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A case of startle epilepsy and SSMA seizures documented with subdural recordings
W Serles1, F Leutmezer, E Pataraia
1Universitätskliniken für Neurologie, Vienna, Austria.
Purpose:
To study the mechanisms of startle-induced supplementary sensorimotor area (SSMA) seizures.
Methods:
We present a patient investigated with indwelling subdural grid electrodes covering both the SSMA and the dorsolateral frontal lobe.
Results:
We found a simultaneous seizure onset in the right dorsolateral premotor cortex and the right SSMA. High-resolution magnetic resonance imaging (MRI) showed a small subcortical lesion adjacent to the right SSMA. The patient became seizure free after resection of the lesion and the ictal-onset zone.
Conclusions:
We conclude that an extended region of abnormally excitable tissue within the frontal lobe could facilitate the generation of startle-induced seizures. We speculate that a widespread epileptogenic zone could help to explain why some patients with SSMA or dorsolateral frontal lobe seizures are more likely to have startle-induced seizures.