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Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
A gut feeling about insular seizures.
S Dionisio1, A Koenig, J Murray
1Comprehensive Epilepsy Service, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia. sashd1@gmail.com
BMJ Case Reports
|June 14, 2012
Summary
This study reports a case of focal seizures presenting as gagging episodes. Successful treatment with antiepileptic drugs highlights the importance of accurate diagnosis for seizure management.
Area of Science:
- Neurology
- Epileptology
- Neuroimaging
Background:
- Focal seizures can manifest with varied and sometimes subtle symptoms, challenging initial diagnosis.
- Gastrointestinal symptoms like gagging can be misattributed, delaying neurological evaluation.
Observation:
- A 43-year-old male presented with gagging, hypersalivation, and lachrymation episodes over two years.
- Electroencephalography (EEG) indicated right anterior temporal epileptiform discharges.
- Magnetic Resonance Imaging (MRI) identified a lesion in the right insular cortex.
Findings:
- Video-EEG telemetry confirmed the gagging episodes as focal seizures originating from the right insular cortex.
- The patient experienced no further seizures after initiating antiepileptic drug therapy.
Implications:
- This case underscores the necessity of considering focal epilepsy in patients with unexplained autonomic and gagging symptoms.
- Accurate localization using EEG and MRI is crucial for effective treatment of refractory epilepsy.
- Prompt diagnosis and appropriate antiepileptic drug management can significantly improve patient outcomes and quality of life.
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