Abstract
BackgroundEpilepsy is one of the most common chronic neurological diseases. Despite the great variety and prevalence of antiepileptic drug treatments, one-third of epilepsies remain drug resistant. The frontal lobe is extensive, and frontal lobe seizures are difficult to locate, which increases the difficulty of the preoperative localization of the epileptogenic zone.Case presentationTwo previously healthy girls with refractory frontal lobe epilepsy showed significant perfusion abnormalities in the right frontal lobe using the cerebral blood perfusion (CBF) quantitative analysis system. They became seizure-free after lesionectomy of the frontal lobe by ASL combined with electroencephalography (EEG) rapid localization. The histopathological diagnosis was focal cortical dysplasia (FCD) type IIa and IIb.ConclusionsThe positive outcome suggests that the combined use of ASL with EEG could be a beneficial option for the presurgical evaluation of pediatric epilepsy.
Highlights
Epilepsy is one of the most common chronic neurological diseases
The positive outcome suggests that the combined use of Arterial spin labeling (ASL) with EEG could be a beneficial option for the presurgical evaluation of pediatric epilepsy
Frontal lobe epilepsy is characterized by various types of seizures depending on the area of the frontal lobe involved, and it often requires surgical management, especially for patients with focal cortical dysplasia (FCD)
Summary
ASL has emerged as a new magnetic resonance imaging method for measuring cerebral blood flow, and it is characterized by its simplicity, nonradiogenicity, high spatial resolution, and good reproducibility. ASL has been successfully applied in clinical studies of many types of diseases; it is rarely used to assist in localizing epileptogenic regions in MRI-negative children with focal epilepsy. To the best of our knowledge, this is the first case report of the use and consequent analysis of the ASL technique in identifying epileptogenic regions in pediatric frontal lobe epilepsy patients. We believe that the experience of our two cases would encourage a larger use of this convenient method for the presurgical study of cortical epileptogenic lesions in epilepsy
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