PMC5707212_01
Facial expression of the patient with ictal pouting and distress. This seizure pattern ends with contraction of the chin.
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Lowering of the labial corners at the very end accompanied by contraction of the chin (Fig. 1, Video 1).
Fifth seizure; the first arrow marks an abrupt attenuation change of background activity with ictal EEG onset, and the second arrow indicates the beginning of ictal pouting and clinical seizure onset.
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The EEG background activity suddenly changed at the onset of seizures, with diffuse attenuation and subsequent rhythmic delta activity bilaterally before changing to spike-and-waves that were dominant over the right hemisphere during the last 3-4 s (Fig. 2, Fig. 3).
Sagittal (a & b), axial (c), and coronal (d) brain MRI revealed a hyperintense lesion consistent with focal cortical dysplasia (FLAIR sequence).
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Brain MRI revealed focal cortical dysplasia on the right mesial frontal lobe and ACC (Fig. 4).