Abstracts

Rationale: Most of patients with atypical benign partial epilepsy (ABPE) are suffering from poor school performance including writing, calculation, reading and phonation problem. The correct diagnosis was sometimes difficult to make in the early stage since seizure semiology and EEG findings are silimar to those of benign rolandic epilepsy. To characterize the remote effect of spike discharges frequently appearing in the rolandic areas in patients with ABPE, we performed SPECT study and compared to the normal control. Methods: Two right-handed patients with ABPE ( 7 years old) had frequent rolandic seizures, atypical absence, head drop seizures since 3 and 4 years old, respectively. EEG showed bilateral spikes and spike-waves in both rolandic region. CSWS was sometimes observed in both patients. MEG also showed dipole localization in the bilateral rolandic areas in one and rolandic area and sylvian fissure in another. At the peak of frequent seizures, both had disturbed oral function, decrease in speech, dysarthria, dysgraphia, and dyscalculia. ECD-SPECT study was preformed at this period, when both patients admitted to our hospital for seizure control and preoperative evaluation of seizure type. IQ was 75 and 53, respectively. After diagnosing ABPE, we used ethosuximide in one and ethosuximide and acetazolamide in another, which resulted in complete disappearance of seizures and dramatic improvement of school performance as well as remarkable improvement of EEG. Results: ECD-SPECT analyzed with e-ZIS clearly showed significant hypoperfusion in the left inferior frontal cortex in both patients. However, the second SPECT in one patient, which was studied after the gain of seizure control, showed normal perfusion in the same region.Conclusions: This study first showed remote effect of rolandic discharges to the speech processing region in ABPE. A long lasting frequent seizure period might bring permanent or more profound effects on this area. A precise mechanism of this remote effect remains to be elucidated.