Reflex eating seizures of opercular origin have been reported and characterized by using surface video-EEG. We report the case of a woman with nearly continuous reflex seizures of opercular origin which were studied with depth-electrode recordings and cured with focal cortical excision.
CASE REPORTA 5 1 -year-old woman developed epilepsy at the age of 33 years. There were no personal or family risk factors for epilepsy, including febrile convulsions. Initially, her seizures were characterized by a sudden and brief ascending epigastric sensation with nausea accompanied by noisy breathing and chattering teeth. A diagnosis of epilepsy was made after a secondarily generalized seizure, and she was treated successfully with sodium valproate (VPA). VPA was discontinued at the age of 43 years, and she remained seizure free for another 4 years. At that time, seizures recurred and their frequency increased progressively, with evolving semiology. Beginning with the same manifestations as years earlier, seizures continued with a perception that sounds were fading away associated with an indescribable feeling in the Accepted October 23. 199X. Address correspondence and reprint requeqts to Dr. A. Biraben at Servicc tie Neurologie, CHR Pontchaillou, Rue Henri Le Guilloux, Rcnnes, France. left side of her body. Other subsequent features included salivation, fear, and breathing difficulty, a sensation of constriction of the throat, anarthria, and then clonic jerks of the left side of her jaw which sometimes spread to both sides of the face. Loss of consciousness was variable as were simple autoinatisins involving her hands.The first episode of status epilepticus occurred at age 46 years, probably triggered by antidepressant medication. After that time, until operation 2 years ago at age SO years, she had many seizures each day, despite trials of several antiepileptic drugs (AEDs). Secondarily generalized convulsions occurred once or twice per week. Two further episodes of status occurred, and she remained in hospital because of increasing numbers of seizures. These occurred either spontaneously or were triggered by movements associated with eating, speaking, or swallowing. Neither the thought of eating nor the sight or smell of food triggered seizure. Similarly, somatic stimulation (touching, pinprick) outside the oropharyngeal area did not elicit seizures. She experienced several frightening episodes of choking associated with periods of nearly continuous seizure activity (diagnosed on the basis of surface EEG recorded at the referring hospital).Interictal EEG performed during seizure-free periods demonstrated focal right temporal slow activity. Video-EEG carried out at the age of 48 years captured seizures every 10 min, each lasting 30-60 s. At the time of our evaluation, it was impossible to determine with certainty which seizures were reflex and which were spontaneous 655
