Epileptic Disorders


Temporal lobe epilepsy with a contralateral parietal seizure-onset zone Volume 23, issue 5, October 2021


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1 The George Washington University School of Medicine and Health Sciences, Department of Neurology, Washington DC, USA
2 Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Neurology, Boston MA, USA
* Correspondence:Mohanad AlGaeed Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Neurology, 330 Brookline Ave, Boston, USA

Achieving sustained seizure freedom following epilepsy surgery remains a challenge in some patients. Lesional temporal lobe epilepsy (TLE), for example, in patients with mesial temporal sclerosis or other MRI abnormalities, carries a good prognosis for seizure freedom compared to significantly lower chances of seizure freedom in patients with non-lesional epilepsy. However, even in some lesional TLE cases, persistent post-operative seizures suggest seizure onset from a brain region that is clinically and electrographically silent but manifests only after propagation to the temporal lobe. A notable example of such a brain region is the parietal lobe, which has extensive connectivity to various brain regions. While certain seizure semiologies, for example, sensory seizures, suggest parietal lobe onset, some medial parietal seizures may be semiologically indistinguishable from temporal lobe seizures. Here, we report a patient with focal impaired awareness seizures that manifested semiologically and electrographically as left TLE but proved to originate from the contralateral medial parietal lobe. We discuss putative seizure propagation pathways.