Surgical Treatment for Mesial Temporal Lobe Epilepsy Accompanied with Neuro-Behçet’s Disease: A Case Report

Hirofumi IWAMOTO; Ryosuke HANAYA; Surya Pratama BRILLIANTIKA; Masanori SATO; Hiroshi HOSOYAMA; Toshiaki OTSUBO; Fujio UMEHARA; Koji YOSHIMOTO

doi:10.2176/nmccrj.cr.2020-0218

Case Reports

Surgical Treatment for Mesial Temporal Lobe Epilepsy Accompanied with Neuro-Behçet’s Disease: A Case Report

Hirofumi IWAMOTO, Ryosuke HANAYA, Surya Pratama BRILLIANTIKA, Masanori SATO, Hiroshi HOSOYAMA, Toshiaki OTSUBO, Fujio UMEHARA, Koji YOSHIMOTO

Author information

Hirofumi IWAMOTO
Department of Neurosurgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan
Ryosuke HANAYA
Department of Neurosurgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan
Epilepsy Center, Kagoshima University Hospital, Kagoshima, Kagoshima, Japan
Surya Pratama BRILLIANTIKA
Department of Neurosurgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan
Masanori SATO
Department of Neurosurgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan
Epilepsy Center, Kagoshima University Hospital, Kagoshima, Kagoshima, Japan
Hiroshi HOSOYAMA
Department of Neurosurgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan
Epilepsy Center, Kagoshima University Hospital, Kagoshima, Kagoshima, Japan
Toshiaki OTSUBO
Fujimoto General Hospital, Miyakonojo, Miyazaki, Japan
Fujio UMEHARA
Department of Neurology, Nanpuh Hospital, Kagoshima, Kagoshima, Japan
Koji YOSHIMOTO
Department of Neurosurgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan

Keywords: acute and chronic progressive types, anterior temporal lobectomy, hippocampal sclerosis, interleukin-6, parenchymal syndromes

JOURNAL OPEN ACCESS FULL-TEXT HTML

2021 Volume 8 Issue 1 Pages 405-411

DOI https://doi.org/10.2176/nmccrj.cr.2020-0218

Details

Abstract

Behçet’s disease (BD) is a rare chronic inflammatory disease associated with systemic vasculitis. Involvement of the nervous system in BD is called neuro-BD (NBD). Epilepsy related to NBD is uncommon but responds well to anti-epileptic drugs. We present a case of NBD with drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). The patient presented with headache, dizziness, disorientation, and generalized seizures. Magnetic resonance imaging (MRI) identified pontine lesions. Chronic inflammation was suspected, and steroid pulse therapy improved his symptoms. He relapsed 1 year after onset and was diagnosed with NBD. MRI revealed bilateral mesial temporal lesions, with the right being edematous and the left atrophic. NBD was controlled by steroid and immunosuppressive medication. Three years after the onset of NBD, the patient suffered MTLE, and MRI suggested left hippocampal atrophy. His seizures became drug-resistant and surgical therapy was considered 12 years after NBD onset. Pre-surgical MRI clearly showed left HS. After evaluations, the patient had left anterior temporal lobectomy (ATL) 13 years after NBD onset under stable NBD. The patient was seizure-free for > 2 years after surgery. Surgery will be an effective treatment for drug-resistant MTLE with HS even in patients with NBD, of course the effects of surgical intervention should be considered.

Corresponding author

Register with J-STAGE for free!