Olfactory prodromal symptoms and unilateral olfactory dysfunction are associated in patients with right mesial temporal lobe epilepsy

Abstract

Purpose: We report a patient with mesial temporal lobe epilepsy (MTLE) with olfactory prodromal symptoms manifested as an unpleasant smell of onions, who was found to have an ipsilateral deficit of olfactory naming (olfactory agnosia). Methods and Results: Preoperative olfactory testing revealed a selective right-sided olfactory deficit for naming of odors. Olfactory threshold was within the normal range. The patient has been seizure free after selective amygdalohippocampectomy for 4 months. No olfactory prodromal events have occurred since surgery. Olfactory testing 3 months after resection showed that right-sided odor naming was still impaired. Conclusions: We conclude that olfactory prodromal symptoms may be associated with unilateral olfactory dysfunction, and lateralization of seizure origin may be possible by unilateral olfactory testing.