A case of temporal lobe epilepsy with improvement of clinical symptoms and single photon emission computed tomography findings after treatment with clonazepam

Abstract

A 26-year-old female presented psychomotor seizures, déjà vu and amnestic syndrome after meningitis at the age of 14 years. Repeated electroencephalograms (EEG) demonstrated occasional spikes localized in the right temporal region in addition to a considerable amount of theta waves mainly in the right fronto-temporal region. Single photon emission computed tomography (SPECT) showed a marked hypoperfusion corresponding to the region in which the EEG showed abnormal findings, although magnetic resonance imaging (MRI) demonstrated no abnormal findings associated with the clinical features. Treatment with clonazepam in addition to sodium valproate resulted in a remarkable improvement of clinical symptoms (i.e. psychomotor seizures and déjà vu), as well as of the EEG and SPECT findings. The present study suggests that SPECT is a useful method not only to determine the localization of regions associated with temporal lobe epilepsy but also to evaluate the effect of treatment in temporal lobe epilepsy.

Many Faces of Déjà Vu: A Narrative Review

“…The patient kept having psychomotor seizures, but without further déjà vu episodes. What is interesting about this case is a subsequent SPECT finding of improved hypoperfusion in her brain lesions associated with psychomotor seizures and the authors concluded that clonazepam was the likely cause despite there being no known effects of clonazepam on brain perfusion (Ide et al 2000).…”

“…An interesting case of temporal lobe epilepsy accompanied by déjà vu experiences was reported by Ide et al of a patient with a history of psychomotor seizures (Ide et al 2000). During the treatment of the seizures with sodium valproate the patient started experiencing déjà vu episodes.…”

Dreaming and unilateral brain lesions: A multiple lesion case analysis.

“…Of these, the content of the dreams was described in 16 cases. The dreams were described as night terrors, nightmares, or as comprising strongly negative emotions in 13 of the 16 cases (Epstein, 1967, 1979; Epstein & Freeman, 1981; Huppertz, Franck, Korinthenberg, & Schulze-Bonhage, 2002; Ide, Mizukami, Suzuki, & Shiraishi, 2000; Lombroso, 2000; Montplaisir, Laverdiere, Saint-Hilaire, Walsh, & Bouvier, 1981; Reami, Silva, Albuquerque, & Campos, 1991; Rodin, Mulder, Faucett, & Bickford, 1955; Snyder, 1958;). The epileptic focus was in the right hemisphere in 9 of the 13 cases with unpleasant dreams (nonsignficant) and all three cases with emotionally “neutral” dreams (Alliez, Roger, & Miaille, 1978; Epstein & Ervin, 1956; Reami et al, 1991).…”

Déjà vu phenomenon-related EEG pattern. Case report

“…Ide et al [17] performed a SPECT investigation in a patient with frequent DV auras and detected hyperperfusion in the right temporal and frontal lobes. Following pharmacotherapy, the frequency of seizures and DV episodes decreased, and the perfusion characteristics returned back to normal.…”