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Figure 1.
Independent seizures from right and left temporal lobes. (A) At age 31 years, EEG captured a typical focal non-motor seizure with déjà-vu at onset during photic stimulation at 30 Hz. The patient was able to signal onset by waving her right hand and to respond to the physiologist. She touched her nose briefly with her left arm. She exhibited involuntary chewing and gulping which appeared to impede speech. She made a rapid recovery. Electrographically, this event began with a single right frontal sharp theta transient. After she indicated the onset of symptoms, there was a build-up of right fronto-temporal theta, evolving into right fronto-temporal delta, remaining unilateral. (B) At age 36 years, a focal non-motor seizure occurred whilst the patient was listening to pop music by Rihanna. She glanced up from looking at her mobile phone (which was playing the music), rested her head on her left hand, and pushed the event button with her right hand. After remaining in this position for several seconds, she turned her head further to the left and sat up briefly. A few seconds later, there was unilateral left blinking and mouth movements. Her gaze appeared to deviate right then her right arm moved slowly into a dystonic, extended posture. The event ended abruptly a minute after clinical onset. Electrographically, this event began with rhythmical sharpened transients over the left temporal area, followed by widespread theta, becoming predominantly left temporal. Accelerating contoured activity was then seen with left temporal sharp and wave activity until rapid clinical recovery. Video-EEG of these events is available in the supplementary video .
Figure 1.
Authors
1 Department of Clinical Neurosciences, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
2 Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, NE2 4HH, UK
Correspondence:
Rhys H. Thomas
Department of Clinical Neurosciences, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
We present the case of a 36-year-old teaching assistant with drug-resistant temporal lobe epilepsy with predominantly musicogenic seizures and hypothyroidism. She had a single unknown-onset tonic-clonic seizure from sleep at seven years of age and experienced increasingly frequent episodes of déjà-vu from adolescence. These were not recognized as focal cognitive seizures until she had further tonic-clonic seizures from sleep aged 26 years, by which time the déjà-vu events were more prolonged with [...]