TOOTHBRUSHING EPILEPSY - A REPORT OF A CASE WITH STRUCTURAL AND FUNCTIONAL IMAGING AND ELECTROPHYSIOLOGY DEMONSTRATING A RIGHT FRONTAL FOCUS

Patients with reflex epilepsies may provide insights into cerebral pat hophysiology. We report a patient with an unusual form of reflex epile psy in whom seizures are induced by tooth brushing. Magnetic resonance im aging (MRI) demonstrated a right posterior frontal low-grade tumor predominantly involving the precentral gyrus. Video-telemetry demonst rated right-sided epileptiform activity during a typical induced compl ex partial seizure. An ictal single photon emission computed tomograph y (SPECT) scan showed an area of hyperfusion that corresponded to the MRI lesion on coregistration with a surface-matching technique. A subs equent coregistered interictal SPECT scan demonstrated hypoperfusion i n the same region, Ours is the first report to demonstrate a structura l focus in this unusual form of reflex epilepsy. Possible mechanisms t o explain the induction of the seizures are discussed.