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. 2013 Jun 20:1:85-8.
doi: 10.1016/j.ebcr.2013.04.003. eCollection 2013.

Ictal singing due to right mesial temporal lobe epilepsy involving a bihemispheric network

Eun Mi Lee  1 , Joong Koo Kang  2 , Ga Young Park  2 , Jung Su Oh  3 , Jae Seung Kim  3
Affiliations

Ictal singing due to right mesial temporal lobe epilepsy involving a bihemispheric network

Eun Mi Lee et al. Epilepsy Behav Case Rep. .

Abstract

Singing is a rare ictal symptom of focal epilepsy. Here, we report a case of a right-handed patient who demonstrated ictal singing due to right mesial temporal lobe epilepsy. Subtraction ictal SPECT coregistered to MRI (SISCOM) performed during ictal singing demonstrated areas of hyperperfusion in the bilateral frontal regions (more prominent in the left frontal lobe), bilateral subcortical regions, insular cortices, and bilateral cerebellum in addition to the right temporal area. An intracranial EEG revealed that an ictal singing episode commenced after an ictal rhythm from the right temporal area was propagated to the contralateral side of the left hemisphere. These findings suggest that the symptomatogenic zone for ictal singing includes neural networks from the frontal and temporal regions of both hemispheres rather than specific cortical areas even when the epileptogenic zone is located in the right mesial temporal area, as evidenced in this patient.

Keywords: Epilepsy; Ictal singing; Mesial temporal lobe epilepsy; SPECT.

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Figures

Fig. 1
Fig. 1
(A) Oblique coronal T2-weighted magnetic resonance imaging showing mesial temporal sclerosis in the right hippocampus. (B) FDG-PET, compared to normal age-matched control, showing decreased metabolism in the right medial, lateral temporal, left lateral temporal, and both frontal cortices. (C) SISCOM showing hyperperfusion in the right temporal lobe, bilateral frontal lobe (more prominent hyperperfusion is noted in the left frontal lobe), bilateral basal ganglia, insular cortex, and bilateral cerebellum.
Fig. 2
Fig. 2
Scalp ictal EEG. Ictal injection during ictal SPECT was performed during ictal singing and 10 s before the singing episode finished. However, ictal EEG demonstrated muscle artifacts and nonlateralization.
Fig. 3
Fig. 3
(A) Hippocampal depth electrodes were inserted into occipital burr holes in the occipitotemporal direction, and subdural electrodes were placed through temporal burr holes in order to cover the temporal lobe. (B) Intracranial ictal EEG demonstrating preictal discharge in the right hippocampal depth electrodes, followed by fast low-amplitude activity in the right hippocampal depth electrodes that later propagated to the left hemisphere. Singing was observed several seconds after the ictal rhythm propagated to the left hemisphere.
See this image and copyright information in PMC

References

    1. Bartolomei F., McGonigal A., Guye M., Guedj E., Chauvel P. Clinical and anatomic characteristics of humming and singing in partial seizures. Neurology. 2007;69(5):490–492. - PubMed
    1. Bartolomei F., Wendling F., Vignal J.P., Chauvel P., Liegeois-Chauvel C. Neural networks underlying epileptic humming. Epilepsia. 2002;43(9):1001–1012. - PubMed
    1. Bentes C., Pimentel J., Costa J., Santos R., Rolo V. Ictal singing: case report and reappraisal of the literature. Epileptic Disord. 2008;10(2):113–118. - PubMed
    1. Doherty M.J., Wilensky A.J., Holmes M.D., Lewis D.H., Rae J., Cohn G.H. Singing seizures. Neurology. 2002;59(9):1435–1438. - PubMed
    1. Enatsu R., Hantus S., Gonzalez-Martinez J., So N. Ictal singing due to left frontal lobe epilepsy: a case report and review of the literature. Epilepsy Behav. 2011;22(2):404–406. - PubMed

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