Abstract
Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy (DRE). Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy (LITT), improved the safety and non-invasiveness of this method. Electric and magnetic source imaging (ESI/MSI) plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for 16 years and underwent surgery at Cook Children's Medical Center (CCMC). The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography (EEG), magnetoencephalography (MEG) with simultaneous conventional EEG (19 channels) and high-density EEG (256 channels) in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography (FDG-PET). Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free (Engel 1; 12 months after surgery). Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE.
Highlights
For patients with drug resistant epilepsy (DRE), epilepsy surgery is the safest and most effective therapeutic approach to cure epilepsy (Ryvlin et al, 2014)
This non-invasive phase is followed by invasive diagnostic techniques, such as the intracranial EEG, which are regarded as gold standards for the recording of seizures and localization of the seizure onset zone (SOZ) that offers the best approximate of the epileptogenic zone (EZ)
We localized predominant epileptiform activity in an adolescent who suffered from DRE for 16 years using ESI and MSI
Summary
For patients with drug resistant epilepsy (DRE), epilepsy surgery is the safest and most effective therapeutic approach to cure epilepsy (Ryvlin et al, 2014). Patients referred for epilepsy surgery undergo an extensive presurgical work-up, starting with magnetic resonance imaging (MRI) and EEG with synchronized video registration (videoEEG), and if needed fluorodeoxyglucose - positron emission tomography (FDG-PET) or ictal single-photon emission computed tomography (SPECT) This non-invasive phase is followed by invasive diagnostic techniques, such as the intracranial EEG (iEEG), which are regarded as gold standards for the recording of seizures and localization of the seizure onset zone (SOZ) that offers the best approximate of the EZ. They are costly; can be difficult due to the child’s cooperation; require additional surgical intervention; and are limited to the area of electrode coverage. A boardcertified pediatric epileptologist used the standardized Engel scale to evaluate the patient’s post-surgical outcome from her most recent follow-up visit (Engel et al, 1993)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
