"Dual pathology" and the significance of surgical outcome in "Dostoewsky'sepilepsy"

A patient with a right occipital arterio-venous malformation (AVM) and seiz ures heralded by "lights", and experiencing "ecstasy" underwent a right occ ipital lobectomy after the AVM was embolized. Thereafter,seizures began wit h motor arrest and lip smacking, but never again with "light and ecstasy". A right temporal lobectomy and electrocorticogram (E.Co.G) were performed u nder local anesthesia four years after occipital lobectomy. Abundant spikin g activity was recorded from the right hippocampus which showed gliosis and neuronal loss in the pathology studies. Electrical stimulation of the late ral and basal temporal cortices failed to elicit the vision of "lights" or the experience Of "ecstasy". The patient has had two seizures in the last two years as a result of a lap se in taking his anti-convulsant medication. He now lives alone, seizure-fr ee. The possible abnormally induced functional network organization and str uctures involved in the production of the "ecstasy" phenomenon are discusse d.