Examination And Investigations

The patient was admitted to the Epilepsy Center of the University of Bonn, Germany, 9 months after her initial seizure. Physical examination revealed no focal neurological deficits. She had severe affective abnormalities, consisting of major depression with lability of mood. Neuropsychological testing revealed verbal and visual memory deficits.

A magnetic resonance imaging (MRI) scan showed left-sided hippocampal volume loss with increased T2 signal, indicating hippocampal sclerosis. Interictal EEG revealed bilateral anterior temporal epileptiform discharges (sharp waves, sharp-and-slow waves). Recordings of five habitual seizures showed a uniform left temporal onset of rhythmic theta activity with spread to the contralateral temporal lobe contacts within 6—20 s. Positron emission tomography scanning revealed left temporal hypermetabolism. Ictal single-photon emission computed tomography scanning showed left temporal hyperperfusion. A search for neoplasia, including serum testing for autoantibodies associated with paraneoplastic neurological syndromes, was negative. There were no abnormal values in standard tests of the cerebrospinal fluid, including an extensive serological search for neurotropic infectious agents.

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