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Stereo‐ EEG : Diagnostic and therapeutic tool for periventricular nodular heterotopia epilepsies
Author(s) -
Mirandola Laura,
Mai Roberto F.,
Francione Stefano,
Pelliccia Veronica,
Gozzo Francesca,
Sartori Ivana,
Nobili Lino,
Cardinale Francesco,
Cossu Massimo,
Meletti Stefano,
Tassi Laura
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13895
Subject(s) - stereoelectroencephalography , epilepsy , electroencephalography , medicine , epilepsy surgery , magnetic resonance imaging , neurosurgery , radiology , psychiatry
Summary Objective Periventricular nodular heterotopias ( PNH s) are malformations of cortical development related to neuronal migration disorders, frequently associated with drug‐resistant epilepsy ( DRE ). Stereo‐electroencephalography (SEEG) is considered a very effective step of the presurgical evaluation, providing the recognition of the epileptogenic zone ( EZ ). At the same time, via the intracerebral electrodes it is possible to perform radiofrequency thermocoagulation ( SEEG ‐guided RF ‐ TC ) with the aim of ablating and/or disrupting the EZ . The purpose of this study was to evaluate both the relationships between PNH and the EZ , and the efficacy of SEEG ‐guided RF ‐ TC . Methods Twenty patients with DRE related to PNH s were studied. Inclusion criteria were the following: (1) patients with epilepsy and PNH s (unilateral or bilateral, single or multiple nodules) diagnosed on brain magnetic resonance imaging ( MRI) ; (2) S EEG recordings available as part of the presurgical investigations, with at least one intracerebral electrode inside the heterotopia; (3) complete surgical workup with SEEG ‐guided RF ‐ TC and/or with traditional neurosurgery, with a follow‐up of at least 12 months. Results Complex and heterogenic epileptic networks were found in these patients. SEEG ‐guided RF ‐ TC both into the nodules and/or the cortex was efficacious in the 76% of patients. Single or multiple, unilateral or bilateral PNH s are the most suitable for this procedure, whereas patients with PNH s associated with complex cortical malformations obtained excellent outcome only with traditional resective surgery. Significance Each patient had a specific epileptogenic network, independent from the number, size, or location of nodules and from the cortical malformation associated with. SEEG ‐guided RF ‐ TC appears as a new and very effective diagnostic and therapeutic approach for DRE related to PNH s.