Department of Neurology, Klinikum Großhadern, University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
We report a patient with left temporal lobe epilepsy and a left parietal angioma, in whom ictal SPECT showed hyperperfusion in a spontaneous and an electrically-induced, non-habitual focal seizure. A SPECT investigation during an habitual seizure originating in the left temporal lobe showed a left temporal hyperperfusion. Electrical stimulation of the parietal cortex adjacent to the location of a previously resected angioma using subdural electrodes resulted in a non-habitual seizure beginning with a unilateral somatosensory aura. Ictal SPECT of this seizure demonstrated contralateral central hyperperfusion. We conclude from our findings that ictal SPECT hyperperfusion reflects the activation of symptomatogenic cortex, which can be induced by both epileptic discharge and electrical stimulation.