JLE

Epileptic Disorders

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Gelastic seizures: not always hypothalamic hamartoma Volume 9, issue 4, December 2007

Figure 1 Scalp EEG before and during a typical seizure. No EEG changes were seen. The red line indicates onset of the clinical event.

Figure 2 A) MRI of the patient, FLAIR sequence, coronal, demonstrating an area of high signal in the right frontal lobe that extends from the surface of the cortex into the subcortical area close to the lateral ventricle. B) The same MRI, T1 sequence, high resolution, coronal, demonstrating the same abnormality.

Figure 3 A) Interictal SPECT not revealing any area of hypo- or hyper-perfusion. B) Ictal SPECT, coronal section, revealing a small area of hyperperfusion in the right frontal area, concordant with the MRI findings. C) Subtraction analysis, showing the area of hyperperfusion (white surrounded by red coloration) in the right parasagittal frontal region.

Figure 4 CT performed with the patient having a subdural grid and one line of electrodes, superimposed onto a pre-surgical MRI using Atamai software (London, ON, Canada). The grid is covering the right frontal convexity (A) and the mesial portions (B), while the line is covering the right orbitofrontal region. The recordings using these electrodes revealed an onset concordant with the MRI lesion and the SPECT findings (C).