Radiofrequency ablation of epileptogenic periventricular heterotopia

Abstract

Background. Periventricular heterotopia is one of the causes of the intractable epilepsy. Different treatments of this pathology show variable efficacy.Aim. To present the result of radiofrequency ablation of periventricular heterotopia in a patient with drug‑resistant epilepsy.Materials and methods. 33‑year‑old female patient has been suffering from epilepsy since the age of 19 with frequent focal seizures (up to 70–80 times a month) and bilateral tonic‑clonic seizures (up to 4–6 times a year). In 2018 the patient underwent resection of the right temporal lobe with its medial structures and partial resection of the periventricular heterotopia located in the right lateral ventricle. The frequency of focal seizures after 1st surgical treatment increased till 150 per month, bilateral seizures – up to 3–4 per month. After additional examination stereotaxic radiofrequency ablation of periventricular heterotopia on the right side was performed in 2019 in the Department of Functional Neurosurgery of the Federal Neurosurgical Center (Novosibirsk). In total 5 ablation spots were made in the periventricular heterotopia. Follow‑up period was 14 months. Right after the operation a transient left‑sided hemiparesis has developed (up to 4 score of MRC scale) which regressed by the time of discharge. During 14 months of the follow‑up period the patient had 3 bilateral tonic‑clonic seizures, however, after 2nd surgical treatment focal seizures did not appear.Conclusion. This clinical case demonstrates sufficient efficacy and relative safety of radiofrequency ablation of periventricular heterotopia in drug‑resistant epilepsy.