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Neurology 2003;60:415-421
© 2003 American Academy of Neurology

Spike-triggered fMRI in reading epilepsy

Involvement of left frontal cortex working memory area

J.S. Archer, FRACP, R.S. Briellmann, MD, A. Syngeniotis, BapplSc, D.F. Abbott, PhD and G.D. Jackson, MD

From the Brain Research Institute (Drs. Archer, Briellmann, Abbott, and Jackson, A. Syngeniotis), Austin & Repatriation Medical Centre, Heidelberg West; and Departments of Medicine and Radiology (Dr. Jackson), The University of Melbourne, Victoria, Australia.

Address correspondence and reprint requests to Associate Professor Graeme Jackson, Brain Research Institute, Neurosciences Building, Austin and Repatriation Medical Centre, Banksia Street, Heidelberg West, 3081 Victoria, Australia; e-mail: g.jackson{at}brain.org.au

Objective: To determine the origin of epileptiform activity in reading epilepsy (RE) and the association between these regions and regions activated by reading, and to assess brain morphometry in these areas.

Methods: In two subjects with RE, EEG was recorded inside the three tesla MRI while subjects read silently. Spike-triggered fMRI images were compared to baseline. In a second fMRI study, 30 seconds of silent reading was compared to visual fixation. Morphometry of these areas was assessed using curvilinear surface reconstruction. Left central sulcal patterns in three subjects with RE were compared to three subjects with idiopathic generalized epilepsy (IGE) and 12 normal controls.

Results: One subject with RE showed spike-related activity (17 spikes) in the left precentral gyrus, and bilaterally in the central sulcus and globus pallidus. The other showed no definite activation owing to low spike numbers (4 spikes). In both subjects, the block reading task recruited normal visual and language areas including the left posterior middle frontal gyrus. Two subjects with RE showed an unusual gyrus branching anteriorly off the left central sulcus. A similar sulcal pattern was seen in none of the subjects with IGE and only 1 of 12 controls.

Conclusion: Spike activity overlapped with reading activity in the left middle frontal gyrus, a structure recruited during working memory cognitive tasks. The authors postulate that, because of a local structural anomaly, the spikes of reading epilepsy spread from working memory areas into adjacent motor cortex, activating a cortical subcortical circuit.




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