A Case with the Basal Temporal Epileptic Focus Presenting Neocortical Propagation Detected by Magnetoencephalography.

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  • 脳磁図により新皮質伝播所見を捉えた側頭葉底部焦点の難治性てんかんの１例

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Abstract

The authors reported a case of basal temporal lobe epilepsy in which preoperative magnetoencephalography (MEG) study using a whole-head neuromagnetometer played critical role to identify the epileptic foci. The patient was a 30-year-old man who had been clinically diagnosed as temporal lobe epilepsy but preoperative conventional studies failed to localize the epileptic foci. Estimated equivalent current dipoles (ECDs) for interictal MEG spikes indicated neocortical spike propagation from the basal to lateral temporal cortex, which was supported by the electrocorticogram (ECoG) study following the placement of subdural electrodes. The long-term ECoG monitoring confirmed the seizure onset from the basal temporal cortex. The patient underwent anterior temporal lobectomy with extensive corticectomy while the mesial temporal structures including the hippocampus were preserved. Satisfactory seizure reduction was obtained after the surgery. Higher spatiotemporal resolution of the recent whole-head MEG enabled to detect epileptic foci even on the basal temporal region. It alsoenabled to trace the spike propagation between the distant cortices. The case demonstrated the clinical usefulness of MEG in presurgical decision making, especially for those patients whose epileptic foci were unable to be localized using conventional studies.

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