Non-lesional eating epilepsy with temporo-insular onset: A stereo-EEG study

Abstract

Eating Epilepsy (EE) is a rare and often under-recognized form of reflex epilepsy, which manifests with seizures triggered during meals, with or without spontaneous seizures. The electro-clinical manifestations of EE are distinct with variable response to antiseizure drugs. We report the case of a 34-year-old man who was seen for a 4-year history of drug-resistant focal impaired awareness seizures associated with eating without a structural cause. Scalp video-EEG delineated a right temporal seizure focus with atypical features. Subsequent stereo-EEG revealed synchronized seizure onset from the right mesial temporal region and the right inferior insula. Resective surgery of the involved areas rendered this patient seizure-free with 3 years' follow-up. In non-lesional cases of drug-resistant EE, the epileptogenic zone can be large and deep, and therefore stereo-EEG was helpful in determining the seizure onset zone.

Highlights

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  Eating epilepsy is a rare type of reflex epilepsy, in which seizures are triggered by eating.

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  To date there are only very few case-reports describing the surgical management of eating epilepsy.

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  Stereo-EEG clearly delineated the epileptogenic zone within the temporo-insular network in non-lesional eating epilepsy.

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  Epilepsy surgery can yield a favorable outcome in drug-resistant eating epilepsy.