Abstracts

RATIONALE:To discuss a patient with an unusual form of drug-resistant reflex seizures, activated by the thought of his family home, and treated by temporal lobe resection. METHODS:Single case study, evaluating the patient with video-EEG monitoring, volumetric MRI, and ictal and interictal single-photon emission tomography (SPECT). Treatment of refractory temporal lobe epilepsy with surgical resection. RESULTS: Experiential seizures were reliably activated by thinking about his family home during intensive monitoring. EEG, imaging, SPECT, and neuropsychology testing supported left temporal seizure onset. Seizures ceased after left temporal resection. The surgical specimen showed cortical dysplasia. CONCLUSIONS:_Reflex activation of temporal lobe epilepsy by thoughts or mental images is often suggested by patients but has not been objectively demonstrated before. This patient had experiential seizures reliably activated by thinking about his family home. Dysplastic cortex was found at temporal resection. Such cortex is inherently epileptogenic and can be abnormally connected to surrounding brain. A hyperexcitable and abnormally connected dysplastic region within the structures believed to subserve experiential auras could be involved in these reflex seizures. Reflex experiential seizures may be more common than assumed and these findings give credence to other patients' accounts.