Periventricular nodular heterotopia in adult with temporal epilepsy. Forensic implications

Neuronal heterotopias are malformations of neuronal migration, clinically associated with mental retardation, epilepsy and dyslexia. Nodular heterotopias are usually identified in childhood as part of syndromes associating multiple cerebral and systemic malformations. Milder forms may go unrecognized until adulthood when their initial symptoms are usually seizures. We present the case of a 54 years old woman, who is a medical nurse, with temporal lobe epilepsy, with late recognition of her disease. The clinical presentation suggested temporal lobe epilepsy with complex partial seizures, impaired consciousness and motor automatism. Video-EEG has simultaneously recorded the clinical seizure and the ictal paroxysmal discharges. The cause of the temporal epilepsy was proved to be periventricular nodular heterotopia (PVNH).