目的:言语幻听的存在通常与精神障碍有关,很少被认为是一种发作现象。本文的目的是使用立体脑电图(SEEG)描述癫痫发作和直接皮质刺激期间这种发作症状发生的解剖结构。
方法:该病例是一名31岁的右撇子女性,双边演讲代表,精神分裂症和耐药癫痫以及以发作性言语幻听为特征的局灶性感觉癫痫发作。她被植入了深度电极,用SEEG录音对她进行了监测.
结果:她有局灶性感觉癫痫发作,其特征是言语听觉幻觉,具有以下特征:听到许多声音(男性和/或女性),同时说话(无法区分多少)。声音在她的脑海里,由负面内容组成,持续了两分钟.她的一些局灶性感觉癫痫发作演变成局灶性运动性癫痫发作,很少进展为双侧强直阵挛性癫痫发作。她的神经检查,她的脑部MRI和发作间SPECT没有异常。她的PET扫描发现右侧颞叶和右侧额叶轻度代谢低下。她的神经心理学评估显示语言偏侧性未确定,但功能MRI显示双侧语言表现。在她的视频脑电图上,在右颞后发作时捕获了3次癫痫发作。随后的SEEG显示出13种典型的癫痫发作,起源于颞后部新皮质区域。右颞顶叶后部新皮质区域和右杏仁核的皮质刺激引发了她的典型现象,这是多种声音,在她的脑袋里,用第二个人说话,负含量,无法识别性别,在英语中,也没有侧向化。
结论:应仔细分析言语幻听,因为它们可能是癫痫发作的一部分。我们的案例支持这些幻觉在右后新皮质颞区的定位。
OBJECTIVE: The presence of verbal auditory hallucinations is often associated with psychotic disorders and rarely is considered as an ictal phenomena. The aim of this paper is to describe the anatomical structures involved in the genesis of this ictal symptom during epileptic seizures and direct cortical stimulation using stereo encephalography (SEEG).
METHODS: The case is of a 31-year-old right-handed female, bilateral speech representation, schizophrenia and with drug-resistant epilepsy and focal aware sensory seizures characterized by ictal verbal auditory hallucinations. She was implanted with depth electrodes, and she was monitored using SEEG recordings.
RESULTS: She had focal aware sensory seizures characterized by verbal auditory hallucinations, with the following features: hearing numerous voices (both male and/or female), talking at the same time (not able to distinguish how many). The voices were inside her head, consisted of negative content, and lasted up to two minutes. Some of her focal aware sensory seizures evolved to focal motor seizures and rarely progressed to bilateral tonic clonic seizures. Her neurological examination, her brain MRI and her interictal SPECT were unremarkable. Her PET scan identified mild hypo metabolism over the right temporal and right frontal lobes. Her neuropsychological evaluation showed language laterality undetermined but her functional MRI showed bilateral language representation. On her video-EEG, three seizures were captured with a right posterior temporal onset. A subsequent SEEG showed thirteen typical seizures originating from the posterior temporal neocortical region. The cortical stimulation of the right posterior temporo-parietal neocortical region and right amygdala triggered her typical phenomena, which was multiple voices, inside her head, speaking in the second person, negative content, unable to identify gender, in English, and no side lateralization.
CONCLUSIONS: Verbal auditory hallucinations should be analyzed carefully because they can be part of the seizure presentation. Our case supports the localization of these hallucinations in the right posterior neocortical temporal regions.