PMC7326076_01
Anatomical and functional neuroimaging - coronal sections through the temporal lobes. (A) T2-weighted FLAIR MRI showing right hippocampal hyperintensity. (B) Interictal brain PET-CT - showing bilateral hypo-metabolism in temporal lobes (right >> left).
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F1
T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI scan revealed hyperintense signal in the mesial aspect of the right temporal lobe (Figure 1A), and PET-CT demonstrated bilateral temporal hypo-metabolism, more prominent on the right side (Figure 1B).
A typical seizure sequence lasting approximately 3 min with the corresponding EEG recording illustrated from left to right: (A) The patient is fondling her groin. The Arrow marks the ictal EEG onset over the right temporal regions; (B) The patient is shouting. The Arrows mark the seizure spread over the right frontotemporal regions; (C) The patient is covering herself under her blanket. The arrows mark the seizure end. (The patient gave her written and informed consent for the use of these images in the publication).
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F2
She had no recollection of these events afterward (see Figure 2). Ictal EEG showed right temporal epileptic activity spreading quickly over the right frontotemporal leads (Table 1 and Figure 2).
(A) Blood oxygenation level-dependent (BOLD) in response to fearful facial expressions demonstrated increased bilateral amygdala activity (P < 0.001 uncorrected for ten voxels); (B) Enhanced left amygdala connectivity (PPI) with both insula in response to fearful facial expressions (P < 0.001 uncorrected for ten voxels). The right amygdala did not show any PPI connectivity (not shown in the figure).
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F3
Results indicate, as expected, bilateral amygdala activation in response to fearful compared to neutral faces (Figure 3A). Interestingly, effective connectivity analyses using PPI further revealed enhanced connectivity of the left (but not the right) amygdala with central nodes of the fear circuitry, including bilateral insula and ACC, in response to fearful compared to neutral faces (Figure 3B).