Orbito-frontal epilepsy masquerading as temporal lobe epilepsy - a case report

Temporal lobectomy fails to control seizures in a considerable percentage o f patients who do not have hippocampal sclerosis. One theoretical reason fo r failure of surgery is that some of these patients may in fact have extrat emporal epilepsy. We present a 28-year-old woman with clinical and scalp el ectroencephalogram (EEG) evidence of right temporal lobe epilepsy (TLE) sup ported by functional imaging with interictal positron emission tomography ( PET) and ictal single-photon emission computerized tomography (SPECT). An i nvasive EEG monitoring was prompted by the discovery of a small right orbit o-frontal lesion on MRI. Monitoring documented seizure onset at the lesion, with rapid right temporal involvement. The patient was almost seizure-free after a lesionectomy. The index of suspicion of orbite-frontal epilepsy sh ould be high in patients with apparent TLE when the scalp EEG and neuroimag ing data are not congruent, or if temporal lobe pathology cannot be identif ied on structural imaging. (C) 2001 BEA Trading Ltd.