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Orbito-frontal epilepsy masquerading as temporal lobe epilepsy-a case report.

B Shihabuddin1, B Abou-Khalil, D Delbeke

  • 1Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA.

Seizure
|June 16, 2001
PubMed
Summary

Orbito-frontal epilepsy can mimic temporal lobe epilepsy, leading to surgical failure. Early identification of extratemporal seizure origins, like orbito-frontal lesions, improves surgical outcomes for epilepsy patients.

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Epilepsy research·2006

Area of Science:

  • Neurology
  • Neurosurgery
  • Epileptology

Background:

  • Temporal lobectomy is a common epilepsy surgery, but fails in a significant portion of patients without hippocampal sclerosis.
  • Extratemporal epilepsy is a potential cause for surgical failure in presumed temporal lobe epilepsy (TLE).

Observation:

  • A 28-year-old woman presented with clinical and scalp electroencephalogram (EEG) findings suggestive of right TLE.
  • Functional imaging (PET/SPECT) supported the diagnosis of right TLE.
  • A small right orbito-frontal lesion was identified on MRI, prompting invasive EEG monitoring.

Findings:

  • Invasive EEG monitoring revealed seizure onset originating from the orbito-frontal lesion.
  • Seizures rapidly involved the right temporal lobe.

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  • Lesionectomy resulted in near-complete seizure freedom for the patient.

    • Implications:

    • Orbito-frontal epilepsy should be considered in patients with apparent TLE when EEG and imaging are incongruent or temporal lobe pathology is absent.
    • Accurate localization of extratemporal seizure foci is crucial for successful epilepsy surgery.
    • This case highlights the importance of considering non-temporal origins in refractory epilepsy.