What’s behind drawing for an artist with left temporal lobe epilepsy? A multimodal neurophysiological study

•A left temporal cavernoma caused focal epilepsy facilitated by drawing, in an artist.•Drawing triggered delta activity on left anterior temporal and orbito-frontal areas.•These areas were activated by drawing and the left uncinate fasciculus connecting them was affected.•Neuronal excessive discharges and hyper-synchrony may be facilitated by altered connectivity of different cortical areas. There are few studies in literature reporting drawing as a strong trigger of praxis-induced focal seizures. The aim of the present case report was describing a case of focal epilepsy with praxis induced EEG activation, due to a cavernoma, in the left middle anterior temporal lobe by using a multimodal approach. We combined video-EEG, showing that drawing increased a sustained monomorphic delta activity localized on left anterior temporal region (F7-T1a), diffusing to the vertex (Fz) and the fronto-polar electrodes (F3), with DTI data, showing that the left uncinate fasciculus, connecting the temporal pole to the orbitofrontal cortex, significantly differed from controls. fMRI confirmed that drawing increased activation in these areas. The congruence between findings supports the role of the left uncinated fasciculus linking the temporal lobe to the orbitofrontal cortex in the present focal epilepsy mainly facilitated by drawing.