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Re: EPILEPSY / CORTICAL DYSPLASIA QUERY

Posted By CCF neuro MD MM on October 14, 1998 at 10:13:04:

In Reply to: EPILEPSY / CORTICAL DYSPLASIA QUERY posted by Upendra Patel on October 14, 1998 at 09:30:21:






My son's long disabilitating medical condition has still not been diagnosed.
His appointment with neurologist is some time away and would appreciate any
opinion in respect of epilepsy and/or cortical dysphasia  based on the following
MRI and spect  results.
The MRI conclusion  done in January 98  is " there is a right anterior choroidal
fissure CSF containing cyst which has the typical features of an archnoid cyst.
This distorts the hippocampus, but there is no signal change within the hippocampal
formation. There are appearances in keeping with cortical dysplasia involving
the right superior and to a lesser extent the middle temporal gyrae.  If the
patient's EEG localises  the abnormality to the right temporal region, the cortical
dysplasia is most likely to be responsible for the seizure disorder. "
A Cerebral Perfusion Study  in May 98 using Tc-99 exametazime interpretation is "
the focal area of reduced perfusion to the right anterior parietal cortex has no
MRI correlate and is unexplained, but can be seen in patients with a previous
history of head trauma. Mild asymmetry of perfusion between the temporal lobes may
reflect pyhsiologic side to side variation, although alteration in temporal lobe blood
flow can be seen with temporal lobe epilepsy. Ictal and interictal imaging would be
necessary to further evaluate this possibility. ''
An ICTAL  study was done in September 98. " The patient was injected with technetium
99m HMPAO during an acute ictal episode and SPECT imaging performed 1 hour later. There
is relative hypoperfusion  noted of the left parietal occipital and temporal lobes, with
hyperperfusion  noted particularly in the region of the right temporal lobe extending
posteriorly. Impression:  In the setting of an ictal study, the overall findings are
suggestive of a right temporal focus and correlation with an inter-ictal study and recently
performed MRI would be of use. "
I would appreciate any information on the implication of these results or any other helpful
advice.
Thanking you,
UPI



T
The key to understanding tests in the area of epuilepsy localization is that
ideally all of the tests should point to an abnormality in the same area,
if this works out the area can be surgically removed with a high degree of
confidence of a curative resection. The MRI sacn shows Right temporal,lobe
cortical dysplasia, a developmental abnormality of the brain strongly
associated with epilepsy.The cyst is probably not important.
The spect scan also shows some activity during the seiuzure in this area
which fits nicely with the theory that this is causing the problem.
The perfusion study is less helpful but of all of these test is probably less significant.
If your sons EEg is abnormal in the Right temporal area this suggests that
his epilepsy arised there and could be treated surgically.
We do a great deal of surgery for this specific problem at the Cleveland
Clinic, if you want to be evaluated here the number for appointments is
(216 ) 444 5559
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