A surgical case of frontal lobe epilepsy presenting with globus hystericus due to meningioangiomatosis in the motor area

Abstract

We describe successful surgery for brain tumor, situated in the motor area, assessed by functional brain mapping. A 21-year-old female complained of a choking feeling during sleep since the age of 19. She had been diagnosed with hysteria because there were no epileptic discharges on electroencephalogram and no organic findings on brain CT scan. Her seizures developed right facial twitching with subsequent generalized tonic clonic seizures. MRI showed a tumor located in the right motor cortex. To identify the precise epileptogenic focus and recognize the relationship between the tumor and the clinical manifestation (globus hystericus), we implanted a subdural grid electrode over the lateral cotrtex of the frontal and parietal areas. Subdural grid recordings identified an epileptogenic cortex just behind the tumor, and functional brain mapping demonstrated that the throat areas were widely recognized around the tumor and that electrical stimulation of throat areas elicited clinical symptoms similar to globus hystericus. The tumor was completely resected, i.e, lesionectomy. Histologically, meningioangiomatosis was confirmed. The patient has remained seizure-free for 3 years since the surgery and has returned to work at her previous position.