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Intracranial investigation of a patient with nodular heterotopia and hippocampal sclerosis: dealing with a dual pathology
Author(s) -
Ladino Lady Diana,
Dash Chelsea,
Wu Adam,
TellezZenteno Jose Francisco
Publication year - 2017
Publication title -
epileptic disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.673
H-Index - 53
eISSN - 1950-6945
pISSN - 1294-9361
DOI - 10.1684/epd.2017.0912
Subject(s) - ictal , hippocampal sclerosis , epilepsy , epilepsy surgery , heterotopia (medicine) , medicine , semiology , cortical dysplasia , electroencephalography , neuroscience , psychology , pathology , temporal lobe
The pre‐operative assessment and surgical management of patients with dual pathology is challenging. We describe a patient with drug‐resistant focal epilepsy with hippocampal sclerosis and extensive periventricular nodular heterotopia in the same hemisphere. The semiology, scalp EEG, and imaging were divergent, but the presence of focal interictal and ictal epileptic discharges of the putative ictal onset zone resulted in successful localization of the epileptogenic zone. A less aggressive resection was performed based on intracranial EEG recording. The patient has been seizure‐free for three years since resection. Electroclinical hypotheses and challenges in defining the epileptogenic network are discussed.