Abstract
A 17-year-old female suffered three simple partial visual seizures at the ages of 12,13 and 17 years. Magnetic resonance imaging (MRI) did not show any focal cerebral anomaly. Because of typical changes in electroencephalography, benign epilepsy of childhood with occipital paroxysms (BEOP) was diagnosed. To study benzodiazepine receptor density and functional changes in this particular variety of idiopathic localization-related epilepsy, positron emission tomography (PET) of 11C-flumazenil and 18F-2-fluoro-2-deoxy-D-glucose was performed at rest and during an emotional speech activation task. Flumazenil-PET demonstrated a small epileptogenic focus in the left amygdaloid body and FDG-PET showed hypometabolism in the amygdala and hippocampus. Stimulation by an emotional speech task produced a distinct pattern of regional activation, including the left amygdala and hippocampus. We conclude that functional neuroimaging by PET is a valid method to detect small epileptogenic foci, even when no anatomical changes are visible on MRI scans. The demonstration of a temporomesial epileptogenic focus in BEOP gives further evidence for the heterogeneity of this type of idiopathic localization-related epilepsy, and questions its electroclinical entity.
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