A 35-year-old woman had suffered her first generalized tonic convulsion at the age of 9 years when she was in bed soon after falling asleep. One month later, she had another generalized tonic convulsion, and treatment with antiepileptic drugs was started. She developed gyratory seizures several times a day.
She was admitted to the epilepsy center at the age of 12 because of status epilepticus. She was ataxic and dysarthric. Five seizures were recorded during routine video—EEG monitoring. Her seizure manifestations were conscious versive seizures and gyratory seizures to the left. With treatment the seizure frequency was reduced to one or two nocturnal seizures a week. She was a good student before the onset of epileptic seizures and finished middle school and got a job in a car factory. She was kept on her antiepileptic drug therapy but the versive seizures were not completely controlled until the age of 30.
Her EEGs showed constant continuous slow and sharp waves over the right frontal region. Computed tomography (CT) scans were uninformative, but magnetic resonance imaging (MRI) revealed abnormal irregular cortical formation in the right frontal lobe. MEG showed clusters of MEG spike equivalent-current dipoles (ECDs) in the right lateral frontal lobe where the abnormal cortical lesion was localized (Fig. 44.1). Single photon emission computed tomography (SPECT) with PAO showed regional hyperperfusion in the right frontal region during seizures; no abnormality was noted in the interictal period.
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