Abstracts

Rationale: A 40 year old female patient with refractory musicogenic epilepsy presented for a pre-surgical epilepsy resection evaluation due to frequent intractable and disabling complex partial seizures and seizures with rare secondarily generalization occurring since age 12. Seizures were precipitated from hearing music from the Harry Potter film series and other similar loud and dramatic music. She was evaluated for cerebral localization of seizure onsets to guide further therapy. Our case report illustrates how ictal SPECT/Metabolic imaging assisted in the ictal onset localization. The metabolic imaging was strikingly positive and localizing while the MRI was non lesional. To our knowledge, there is no other similar case report noted in the literature and this article reviews the clinical and radiological elements of this unique case report.Methods: In a suburban Epilepsy center this patient underwent MRI Epilepsy protocol neuroimaging, an 18 FDG Brain PET Scan, and Ictal and Inter Ictal Tc 99 SPECT Neurolite studies along with interictal EEG recordings and several days of Video EEG.Results: The work up for localization identified right temporal onset complex partial seizures. Ictal SPECT imaging identified an approximately 25 % increase in metabolism in the right temporal lobe during seizures compared with the baseline. Seizure semiology and EEG localization was concordant with SPECT localization. The patient had a right temporal lobectomy and remains seizure free over 4 years later.Conclusions: Our case report delineates the clinical and neuroimaging characteristics and metabolic imaging of a refractory MRI non-lesional case of musicogenic epilepsy that was cured with a surgical resection guided by metabolic neuroimgaging.