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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
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.
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.
- 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.