PMC6063982_01
PMC6063982_02
Representative example of electroencephalogram (EEG).. During simultaneous video-EEG recording, we confirmed four complex partial seizures. Sharp and slow waves always occurred from the temporal area at T2, T4 and F8 during the seizure (arrow). Interictal epileptiform discharges were also recorded at T2, T4 and F8.
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Sharp- and- slow waves occurred over the right temporal area at electrode positions T2, T4 and F8 during seizures (Fig. 1).
Representative MR and 18F-FDG PET images.. A: MR images (FLAIR axial and coronal) show an abnormal hyperintense signal (arrow) extending from the ventricle to the cortex in the right posterior-temporal lobe. No other abnormalities (including cerebral infarction) are seen, and cerebral perfusion appears to have remained normal. B: Images from 18F-FDG PET show hypometabolism in the right temporal lobe (arrow), corresponding to the focal lesion on MRI. No abnormal metabolism is seen in other areas, including the vicinity of the shunt catheter (arrowhead).
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Magnetic resonance imaging (MRI) showed high T2/fluid-attenuated inversion recovery (FLAIR) intensity from the ventricle to the cortex in the right posterior-temporal lobe, representing a characteristic transmantle sign seen with focal cortical dysplasia (Fig. 2-A). Fluorodeoxyglucose position emission tomography (FDG-PET) showed hypometabolism in the right temporal lobe, corresponding to the focal abnormal lesion on MRI (Fig. 2-B).
PMC6063982_03
Summary of the clinical course of the patient.. Seizures were occurring three times a week at the time of the first visit to our department. His seizures were uncontrolled despite 3 years of pharmacotherapy. To reduce the risk of infection for further epilepsy surgery, we removed the old shunt. After removal (Day 2), seizures suddenly stopped, although he instead complained of headache. Ventricular enlargement was revealed on CT, and indicated increased intracranial pressure. We therefore performed VP shunt replacement (Day 11). Headaches gradually disappeared along with good decompression of the ventricles. Frequency of seizures was significantly decreased compared to pre-operatively, and only lamotrigine was continued as of discharge from our hospital. Seizures have since remained well controlled (about once every 3 months) with pressure adjustments.
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Seizure has since been well controlled coinciding with pressure adjustments (Fig. 3).