Refractory musicogenic epilepsy and a surgical cure guided by metabolic neuroimaging: A case report

A 40-year-old female patient with refractory musicogenic epilepsy and non-lesional magnetic resonance imaging neuroimaging is highlighted in this report. A right temporal lobectomy was necessary and sufficient to effect a durable surgical cure without recurrence for over approximately 18 years in follow-up while remaining off seizure medications for the prior 16 years. Our case report delineates that this patient was cured with a surgical resection guided by metabolic neuroimaging. This patient was evaluated for cerebral localization of seizure onsets to guide further therapy in an epilepsy center and the evaluation for localization of seizure onset identified that Ictal single photon emission computed tomography (SPECT) imaging identified an approximately 25% increase in blood flow or metabolism in the right temporal lobe during seizures compared with the baseline. Seizure semiology and electroencephalography localization were concordant with SPECT localization.