Table 1 Summary of progress
Preoperative course | 2017: onset of seizure symptoms with behavioral abnormalities during sleep 2018: start of LEV 2019: seizures suppressed by adding CZP 2021: the patient was referred to our hospital because his seizures were not controlled despite the addition of CZP, LCM, and PER |
Test results | Electroencephalography: spiny waves were observed in the bilateral antero-medial temporal regions It was difficult to identify the starting point from EEG findings during seizure Head MRI: no obvious abnormal findings. No hippocampal sclerosis or atrophy FDG-PET: hypoglycemia in the left anterolateral temporal region |
Surgery | Intracranial electrode implantation: subdural electrodes were implanted in the lateral and medial left temporal lobe, and in the frontal lobe. Intracranial electrodes were placed in the lateral and medial left temporal lobe, and frontal lobe. Intracranial EEG during seizure showed repeated spikes in the temporal pole followed by propagation to the lateral temporal lobe Focal resection: resection of the left lateral temporal lobe, including the temporal pole, was performed. Intraoperative hippocampal wave recordings showed a low frequency of spikes, so the hippocampus was preserved |
Post-surgery | Four months postoperatively, FAS recurred. One year after surgery, FIAS disappeared |