A case of intractable epilepsy with two types of postictal mental disorders and two independent ictal onset zones: Study with chronic intractranial EEG/video monitoring

Abstract

A right-handed, 39 year old male had meningitis at age one and two simple febrile convulsions at age five and six. From age 10, he had intractable complex partial seizures (CPS), consisting of impaired consciousness and cyanosis. From age 18, he experienced seizure symptoms of sensory aphasia, version of the head and eyes to the left and two types of postictal mental disorders after CPS. One (Type A) was observed seven times after CPS from age 18 years and 8 months. They lasted for a few minutes to two and half hours, and consisted of dysphoria with occasional postictal sensory aphasia. Another (Type B) was observed four times after CPS and a postictal lucid period from age 20 years and 2 months. They lasted for four minutes to five days, and consisted of fluctuating disturbance of consciousness, stereotyped crying, severe psychomotor excitement and delusions. Long-term intracranial EEG/video monitoring confirmed two independent ictal onset zones in the left hippocampus (LH) and in the left orbitofrontal region (LOF). Left anterior temporal lobectomy was performed at age 22. Seizures and mental symptoms were not observed for 17 years after surgery, and nine years after discontinuation of anti-epileptic drugs. We consider that the dual ictal onset zones could have contributed to his postictal mental disorders, Type A was due to malfunction of LOF induced by propagation of LH onset ictal discharge, and Type B was postictal psychosis associated with dual zones.