A Case of Intractable Frontal Lobe Epilepsy with Epileptogenic Focus Remote From and Independent of the Structural Brain Lesion

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  • Mine Seiichiro
    Department of Neurological Surgery, Chiba University School of Medicine
  • Numata Osamu
    Department of Neurological Surgery, Chiba University School of Medicine
  • Uchino Fukuo
    Department of Neurological Surgery, Chiba University School of Medicine
  • Yamaura Akira
    Department of Neurological Surgery, Chiba University School of Medicine
  • Iwasa Hiroto
    Department of Psychiatry, Chiba University School of Medicine

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  • 器質性病変から独立して形成されたてんかん原性焦点を有する難治性前頭葉てんかんの1例

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We reported a surgical case of intractable frontal lobe epilepsy whose epile-ptogenic focus was remote from and independent of the structural brain lesion. The patient was twenty-six-year-old female suffering from intractable seizures for eight years. Three types of seizure were identified; (1) sudden vocalization during sleep, (2) incomprehensible words following speech arrest and (3) adversive seizure after simple partial attack of left upper limb followed by a secondary generalization. In magnetic resonance image a structural lesion was found in the anterior part of the supplementary motor area in the right madial frontal lobe. Scalp EEG demonstrated that the ictal events started from the right parietal area. Epileptogenic focus was determined at the hand area of the right motor cortex by video-EEG monitoring and functional mapping with chronic subdural electrodes. The lesion was totally removed and pathological diagnosis was astrocytoma grade 2. Since the epileptogenic focus was independent of the lesion, multiple subpial transection was performed to the focus and its surrounding area following tumor removal. The seizure disappeared after the surgery. Surgical strategy for treating patients with structural brain lesion associated with intractable epilepsy was discussed.

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