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Mesial temporal lobe epilepsy versus amygdalar epilepsy: late seizure recurrence after initially amygdalotomy and regained seizure control following hippocampectomy Volume 2, numéro 3, Septembre 2000


   
   Figure 1. Pat. S.O. : Two sections of scalp EEG showing the 15 seconds long regional attenuation with maximum over the right temporal region and cessation of spikes [top, pre-ictal (-15 s)] before clinical seizure onset [top, onset, right margin] as well as the postictal accentuation of spikes and sharp waves (bottom, post-ict. (172 s after onset).



   
   Figure 2. Pat. S.O.: Combined scalp and depth recording. Spontaneous right amygdala seizure onset (8/1-3) accompanied by an epigastric aura. See enlarged detail of the build-up of the discharge in right amygdala at the bottom. ECG, electrocardiogram.



   
   Figure 3. Pat. S.O.: Three sections of another spontaneous seizure onset with a semi-ictal "prelude" (left), followed by a localized right amygdalar discharge (RNA, 8/1-2). Only the relevant four channels out of a 32-channel recording are depicted. RCA ant, right anterior hippocampus; R T2mid and RT2 ant: lateral temporal neocortex, 2nd temporal gyrus; mid at the level of electrode 7; ant, at the level of electrode 8 (see also depth electrode positioning in figure 2).



   
   Figure 4. Pat. S.O.: Repetitive single shock stimulation (1 Hz, 0. 7 ms, 10 V) of the right hippocampus (7/2-3; A) and of the opposite left hippocampus (10/2-3; B) provoked paroxysmal responses in the right amygdala (8/1-2), the primary epileptogenic zone of this patient.



   
   Figure 5. Pat. S.O.: Five sections illustrating the topographical relations of interictal spikes in right amygdala (RNA; 8/1-2) and right anterior hippocampus (R CAant; 7/2-3). As in figure 3 only the relevant four channels out of a 32-channel recording are depicted. R T2mid and RT2 ant: lateral temporal neocortex, 2nd temporal gyrus; mid at the level of electrode 7; ant, at the level of electrode 8 (see also depth electrode positioning in figure 2).



   
   Figure 6. Pat. S.O.: MRI prior to the second surgery (left, bottom) indicating the lesioned right amygdala (white arrow). In order to determine exactly the position of the lesion, the MRI is depicted in such a way that the lesion has been aligned to the CA-CP, and VCA and VCP lines in the so-called proportional grid system of Talairach. The stereotactic electrocoagulation of the right amygdala was targeted at the tip of electrode 8 (right, middle and lower drawing). Atlas figures 124, 79 and 49 are from Talairach and Tournoux [51] depicting the location and extent of the amygdala (NA) in the horizontal plan -16 mm below CA-CP-plane (Atlas figure 124), in the verticofrontal section at -4 mm behind VCA (Atlas figure 79), and in the sagittal plane D 24 mm (24 from midline to right) (Atlas figure 49). The atlas sections are showing the amygdala in its largest extent: The amygdala is defined with the coordinates: horizontal/verticofrontal/sagittal = 0 to -8/-9 to -18/+1 to -8.



   
   Figure 7. Pat. S.O. : MRI following right hippocampectomy and resection of the previously destroyed right amygdala region.