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Epilepsy surgery after bilateral frontal lobe trauma
  1. Aayesha Jalaluddin Soni1,2,
  2. James Butler1,3
  1. 1Department of Medicine, Division of Neurology, University of Cape Town, Cape Town, South Africa
  2. 2Neuroscience Institute, University of Cape Town, Cape Town, South Africa
  3. 3Constantiaberg Mediclinic, Cape Town, South Africa
  1. Correspondence to Dr Aayesha Jalaluddin Soni, Department of Medicine, Division of Neurology, University of Cape Town, Cape Town, South Africa; ajsoni008{at}gmail.com

https://doi.org/10.1136/pn-2024-004178

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    A 42-year-old woman had 4 years of medically refractory post-traumatic epilepsy. 15 years before, she had sustained a gunshot wound to her head, with extensive damage to both frontal lobes and altered personality and executive function. She worked as a cashier and had become more sociable and talkative. Her stereotyped seizure semiology included a rising epigastric sensation ascending to the throat, followed by amnesia, unresponsiveness for 2–4 min and grasping of objects. She would repeatedly look at her phone, without drooling, mouthing movements or falling and without postictal language dysfunction. Afterwards, she would feel nauseated and severely fatigued, causing her to sleep and often she wandered postictally. She had intermittent focal-to-bilateral tonic-clonic seizures (BTCS).

    Figure 1 shows her CT scan of the brain. Because of multiple bullet fragments, we could not perform an MR brain scan. Electroencephalogram (EEG) recordings captured seven right frontotemporal seizures and profuse prefrontal spikes on the left. She underwent insertion of subdural electrodes over both anterior and posterior lateral frontal, anteromedial frontal, subfrontal and inferolateral temporal regions; her seizures were seen consistently to originate in the right anteromedial frontal region. She, therefore, underwent a right anteromedial frontal corticectomy, with no change in behaviour or cognition. There were …

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    Footnotes

    • Contributors JB contributed to the concept, write-up and editing of the document. AS contributed to the write-up and editing of the document.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned. Externally peer reviewed by John Duncan, London, UK.