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Stereotactic cortical resection in non‐lesional extra‐temporal partial epilepsy
Author(s) -
Shields D. C.,
Costello D. J.,
Gale J. T.,
Hoch D. B.,
Eskandar E. N.
Publication year - 2007
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2007.01920.x
Subject(s) - ictal , medicine , hypermetabolism , epilepsy , electroencephalography , lesion , epilepsy surgery , semiology , supplementary motor area , neuroscience , magnetic resonance imaging , radiology , pathology , psychology , functional magnetic resonance imaging , psychiatry
The presentation and treatment of a patient with extra‐temporal non‐lesional partial epilepsy is discussed herein. His clinical semiology was consistent with supplementary motor area seizures; however, MR imaging did not demonstrate a lesion. A region of stable cortical glucose hypermetabolism in the left frontal region was noted with 2‐fluoro‐2‐deoxy‐D‐glucose (FDG)‐PET. This was consistent with the frequent interictal discharges evident over the left fronto‐temporal region and the stereotypic high amplitude ictal discharges arising with highest amplitude from the left frontal region. Epileptiform activity evident on an intracranial 64‐point subdural recording grid placed over the left dorsolateral frontal cortex confirmed a distribution concordant with FDG‐PET findings. The subsequent resection was guided by the PET and EEG findings rather than structural MR imaging, and a limited cortical resection led to an immediate and substantial reduction in seizure frequency.