PMC4150642_01
Surface ictal EEG onset shows rhythmic slow waves over the right frontotemporal areas.
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The surface EEG showed right frontotemporal rhythmic slow wave activity (Fig. 1).
Ictal subdural EEG onset: aura of fear and palpitation.
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The subdural electrodes showed clinical correlation of fear and palpitation with an onset of high amplitude spikes over right mesial temporal lobe strips (R-MT2, 4) (see arrow, Fig. 2).
Ictal subdural EEG: manual automatism and lip smacking.
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The manual automatism and lip smacking started at the appearance of the epileptic discharges at the anterior temporal strip (see arrow, Fig. 3).
Ictal subdural EEG: hugging and kissing and left arm dystonic posturing.
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The emotional hugging and kissing behavior was correlated with the spread of the epileptic discharges in the frontal lobe (see arrow, Fig. 4) and (Fig. 5).
Ictal subdural EEG: end of the kissing behavior, no postictal confusion.
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The end of the kissing behavior was coupled to the offsite of the ictal discharge at the right frontal strips (see arrow, Fig. 6).
Brain MRI shows small cortical and subcortical lesions at the right inferior frontal lobe.
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The lesion was located directly anterior of the insular gyrus and inferior to the inferior frontal gyrus (Fig. 7).
Brain MRI shows symmetrical normal-sized hippocampi.
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The hippocampi looked symmetrical (Fig. 8).
The PET study demonstrates decreased FDG metabolism involving the right temporal lobe.
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The PET scan showed hypometabolism of the right temporal lobe (Fig. 9).