PMC3032659_01
Proton MR spectra from left and right temporo-parietal junction. The major metabolite peaks correspond to cholines (Cho) at 3.22 ppm, creatines (Cr) at 3.02 ppm, N-acetylaspartate (NAA) at 2.02 ppm. Axial T2 weighted MR image showing the voxel position at temporo-parietal junctions used for proton MR spectroscopy. Note that the splenium of corpus callosum is normal.
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F1
In addition NMR spectroscopy evidenced no alteration in the right and left temporo-parietal junction (Figure 1).
Interictal brain SPECT with 99mTC-ECD showed a cerebral hypometabolism in both right and left parietal and occipital lobes.
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F2
Autoscopic seizures. A: slow (3.5 Hz) right centro-parietal activity. Patient reported an unclear change in the awareness of her body, a feeling of strangeness. B: abrupt discharges constituted by polyspikes and sharp-waves of 100-120 uV in amplitude and in reversal phase at P4 lead. Patient reported a sudden appearance of her entire body exactly in front of her, in upright position. The double was at the same level of her real body, i.e. the real body was not felt elevated relatively to her double (unlike in out of body experience). She reported a bilocation state. The double was motionless and silent. C-D: after a few seconds the discharge involved right fronto-temporal channels and then left parieto-occipital channel. The discharge lasted about 30 seconds. We noted an impairment of consciousness. E: the final critic activity was constituted by right temporo-parietal spike and slow wave complexes (3.5-4 Hz). Patient reported again un unclear perception of her body, but the double had vanished. F: slow generalized interictal activity recorded by a previous EEG (3-3.5 Hz).
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F3
A previous interictal EEG showed sporadic posterior bilateral slow wave activity 3-3.5 Hz (Figure 3F). We recorded a video-EEG during one of her autoscopic experiences showing an epileptic activity (Figure 3) consisting of a brief (about 1 second) and slow (3.5 Hz) right centro-parietal activity followed by abrupt discharges represented by fast activity of polyspikes and sharp-waves of 100-120 uV amplitude and in reversal phase at the P4 lead.