Epileptic seizures with reversible lesions in bilateral frontoparietal lobes: A case report and literature review

Magnetic resonance imaging (MRI) is recommended for patients with epileptic seizures to rule out an underlying focal lesion. However, the radiological characteristics of epilepsy are not well elucidated. Transient periictal MRI abnormality (TPMA) refers to reversible MRI signal changes observed in epileptic patients. A 32-year-old man presented with a 2-week history of epileptic seizures, which initially manifested as focal aware seizures and progressed to a generalized tonic-clonic seizure on the third day. Electroencephalography showed sharp waves, sharp and slow wave complexes, and irregular δ waves over bilateral temporal lobes. After admission, brain MRI showed abnormal signals in the bilateral frontoparietal lobes. He was administered oral oxcarbazepine (75  mg twice daily). During follow-up he was seizure-free; the abnormal MRI signals persisted at 2 weeks, but were completely resolved at 4 months. The possibility of TPMA should be considered in patients with epileptic disorders, and differentiated from a potential epileptogenic lesion.