[Higher cortical dysfunctions and image diagnosis in a 9-year-old girl with complex partial epilepsy caused by focal...

A 9-year-old right-handed girl was admitted because of complex partial seizures, left-right disorientation and finger agnosia. At the age of 2 years, she began to have seizures, which were exacerbated by carbamazepine and diazepam. Subsequently she was treated with phenytoin and phenobarbital, and remained seizure-free for four years. After age 7, she began to have attacks of alteration of consciousness, which lasted 10 seconds and occurred every two or three months. At age 9, neuropsychological testing revealed borderline intellectual functioning (WISC-R:FSIQ 83, VIQ 94, PIQ 73), but selective deficits were found in tests of calculation and spatial-figural relationships. Axial spin echo (3,000/22) image showed an abnormal high signal intensity in the left temporo-parieto-occipital lobe, in which interictal IMP-SPECT demonstrated decreased cerebral blood flow. These results seemed to explain the relationship between clinical findings and focal migration disorder. It is important to detect a focal migration disorder in patients with intractable focal epilepsy or higher cortical dysfunctions.