An epileptic seizure can be induced by higher brain function or mental processes associated with emotion. The precipitation involves verbal, non-verbal and specific thinking with emotion. Some of these patients have symptomatic and focal epilepsies. Others were idiopathic epilepsies, where the hyperexcitable regions and systems provoked by some specific stimuli may produce epileptic seizures that results in symmetrical, asymmetrical, or even localized clinical manifestations. The understanding of precipitation of seizures by higher brain function may contribute to understanding of epileptogenesis and nosology of epilepsies.
brain function ; Seizures ; Comprehension ; Precipitation ; Epilepsy

Preface
 We have been carrying out a project to improve epilepsy care in Mongolia since 2002, in collaboration with the global campaign of WHO, ILAE (International League Against Epilepsy) and IBE (International Bureau for Epilepsy).
Epilepsy in Mongolia
 In Mongolia, the number of patients with epilepsy has been increasing. The current problems of epilepsy care in Mongolia are as follows:
1) There are few epilepsy specialists, including surgeon, resulting in insufficient management of epilepsy care.
2) Few diagnostic instruments such as EEG, CT, MRI, blood testing are available even in the capital city, Ulaanbaatar. In addition, these tests are very expensive.
3) Lack of drug supply and incomplete health insurance system prevent many patients from stable long-term treatment.
4) Difficulty in access to medical institution due to immature infrastructure of transportation hampers early diagnosis and appropriate treatment.
Our activities
 We developed a program for improving epilepsy care. Three workshops were held in Ulaanbaatar where 50-150 physicians participated (2002, 2007 and 2008) for lectures and case discussions. We also accepted a neurologist for training of epileptology at our institute. We offered two analogue EEG machines along with necessary consumables.
Future prospects
 Most important in Mongolia may be to bring up epileptologists and establish epilepsy network. Because of the chronic shortage of human and medical material resources, there should be a center of epilepsy treatment in Ulaanbaatar, where medicine and consumables can be steadily supplied and transported, and the information network be prepared. Recently, an educational program of the epilepsy for the general public, “Quality Of Life Program”, has been undertaken, which is of high significance in Mongolia to solve stigma and to prevent epilepsy.

Objective To investigate the lateralizing value of figure"4"sign,an asymmetrical tonic posturing observed in secondarily generalized tonic-clonic seizures(sGTC),in patients with mesial temporal lobe epilepsy.Methods Presurgical videotapes of 54 sGTC from 33 patients who were seizure-free for at least 4 years after temporal lobectomy were retrospectively reviewed.Attention was paid to the relationship between the extended upper extremity in figure"4"sign and the resected side.Results The "4"sign was observed in 10(30%)of 33 patients and 23(43%)of sGTC.The extended arm in figure "4"sign was always contralateral to the epileptogenic foci(resected side).Conclusion"4"sign has a significant lateralizing value,when present,in this selected homogeneous group of patients.

Current problems of epilepsy care in Mongolia consist of shortage of health care personnel, limited diagnostic facilities, insuffi cient supply of the antiepileptic drugs, and diffi culty in access to medical services. There is also lack of epilepsy knowledge among the professionals, patients, families as well as the public. There are many patients with epilepsy caused by preventable head trauma. Several initiatives to improve epilepsy care took place in Mongolia in recent years, including educational seminars for physicians in corporation with international organizations, workshops for professionals, patients and families, and training of Mongolian physicians overseas. Although epilepsy care in Mongolia has been improving steadily in the recent years, continuing international cooperation will further improve the quality of care.

We report a case of 74-year-old lady, presented with recurrent jargon aphasia as simple partial status epilepticus (SPSE) which lasted for a few days to a few weeks, following a brain abscess removal from the left temporo-parieto-occipital region at the age of 71 years. The ictal activity on electroencephalogram was documented at left posterior quadrant, where marked hyperperfusion was clearly visualized by perfusion image acquired with magnetic resonance imaging (MRI) using pulsed arterial spin-labeling (PASL). Jargon aphasia as a primary feature of simple partial status epilepticus is so uncommon that only few cases have been reported. Furthermore, this report suggests that MRI using PASL is a promising method not only to localize the seizure foci but also to follow up the corresponding regional cerebral blood flow changes noninvasively.