Gray matter heterotopy as a cause of seizure: purpose of a case diagnosed in adults

Context: Epilepsy affects more than 50 million people worldwide, which is an important cause of morbidity and functional limitations. Cortical development malformations represent about 8% of epilepsy cases, and are associated with cognitive deficits, that are frequently diagnosed in childhood. Case report: L.G.M, female, 35 years old, was attended in an emergency department with psychotic symptoms, aggressiveness and lowering of the sensorium. Computed Tomography (CT) scan of the brain evidenced hypodensity and loss of cortico-medullary differentation in the left temporo-parietal region. The neuroimaging findings motivated the referral to our service for investigation. Upon admission, has been shown a history of frequent focal motor and non-motor seizures associated with cognitive deficit since the age of 12. During hospitalization, a Magnetic Resonance Imaging (MRI) of the brain was performed, which showed subependymal heterotopy of gray matter (Figures 1 and 2). Since then, the monotherapy treatment with carbamazepine aiming at seizure control was chosen. Discussion and conclusion: Cortical development malformations can be classified into three groups of abnormalities, such as: 1) neuronal and glial proliferation and apoptosis; 2) neuronal migration; 3) cortical organization. A heterotopy of the gray matter is related to the migration disorder of the germinal matrix neurons on the wall of ventricle lateral to the cortex. It is the most frequent anomaly of cortical development. The perception of cognitive deficit associated with epileptic seizures should always awaken to the need for early investigation by image examination, in particular brain MRI, in order to diagnose possible malformations of cortical development.