Disconnecting surgery at alveus and cornu ammonis of hippocampus, amygdala superficialis, and amygdala medial nuclei for
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CASE REPORT
Disconnecting surgery at alveus and cornu ammonis of hippocampus, amygdala superficialis, and amygdala medial nuclei for epilepsy associated with attention deficit hyperactivity disorder Zamzuri Idris 1,2,3 & Zaitun Zakaria 1,2,3 & Sanihah Abdul Halim 3,4 & Salmi Abd Razak 3,5 & Abdul Rahman Izaini Ghani 1,2,3 & Jafri Malin Abdullah 1,2,3 Received: 1 August 2020 / Accepted: 16 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The neural basis for epilepsy and attention deficit hyperactivity disorder (ADHD) is currently incompletely known. We reported a young girl with both epilepsy and ADHD, who had a calcified lesion in the right basolateral amygdalo-hippocampal region extending to the ventral striatum. The child underwent disconnecting surgery and biopsy of the lesion. Fascinatingly, the child’s behavior changed immediately after the surgery from inattentive and impulsive to nearly normal behavior experiencing no more breakthrough seizures since after 3 years of surgery. The Schaltenbrand Wahren Brain Atlas revealed alveus, cornu ammonis, amygdala superficialis, and medium as the disconnected region in this surgery. Keywords Epilepsy . Attention deficit hyperactivity disorder . Amygdala . Hippocampus . Ventral striatum
Introduction Various clinical studies have noted the coincidence of epilepsy with attention deficit hyperactivity disorder (ADHD) that commonly preceded the diagnosis [1–3]. ADHD is a clinically
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00381-020-04893-z) contains supplementary material, which is available to authorized users. * Zamzuri Idris [email protected] 1
Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia
2
Brain And Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia
3
Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab 2, 16150 Kota Bharu, Kelantan, Malaysia
4
Neurology Unit, Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia
5
Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
heterogeneous disorder of inattention, impulsivity, and hyperactivity. The pathophysiology is still incompletely understood. Several abnormal loci are identified from neuroimaging studies, such as abnormal microstructural architecture of basolateral nucleus of the amygdala and striatum when compared with healthy individuals [4–7]. On the contrary, an enlarged head of hippocampus was postulated to represent a neural compensation for disturbances in the prefrontal and other nodes [4, 8]. Functional neuroimaging, regional cerebral blood flow, or positron emission tomography disclose marked abnormalities within the
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