Diffusion-weighted imaging (DWI) is a novel technique to delineate focal areas of cytotoxic edema in the various diseases. DWI may also detect the epileptogenic region during early and late postictal periods in patients with epilepsy. We evaluated apparent diffusion coefficient (ADC) as a DWI parameter in a patient with West syndrome. Serial MRI scans (Siemens 1.5 Tesla system) were performed both at onset and after the end of seizures. At onset, ADC value was decreased in the brain stem. After the end of seizures, ADC value of the brain stem increased to the normal range. No significant changes of ADC values were recognized in the other regions. These results suggest that brain stem may be the epileptogenic region in West syndrome, and that serial ADC values may provide useful information to identify the epileptogenic region in epilepsy.

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Eating epilepsy manifesting all the seizures only after meals is rarely reported in Japanese, and we herewith report a 26-year-old man with eating epilepsy. The patient started having a series of auras (depersonalization, funniness and aphasia) since the age 20 years, loss of awareness attacks since age 24 and generalized convulsions since age 26. All of those attacks occurred within a half or an hour after meals. There was no family history of epilepsy. General and neurological examination was normal. Brain MRI and FDG-PET were normal and repeated EEGs recorded intermittent irregular slow and ill defined sharp transients in the left middle temporal area. The patient could describe a series of auras which consisted of depersonalization associated with machinery rhythmic sensation, funniness and impaired verbal recognition and expression. In this patient, it was most likely that gastric distension by meals gave rise to autonomic afferent stimuli that subsequently elicit epileptic activity in the limbic system and spread to the language area, without consciousness disturbance during a series of auras.

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