Abstract
Nonlesional neocortical epilepsy (NLNE) is a challenging problem to treat. Medical management with antiepileptic drugs (AEDs) frequently fails, and surgical management of refractory epilepsy is often required. With precise electrophysiological localization and resection, seizure reduction and even remission can be achieved. Frequently, lesional tissue is discovered in resected tissue specimens, even when not identified preoperatively by brain MRI. In this review, we describe the diagnostic and surgical approach to patients with NLNE refractory to medical management.
Highlights
Epilepsy is characterized by recurrent unprovoked seizures and has an estimated prevalence of about 5-15 per 1000 [1]
In most cases of neocortical epilepsy, intracranial EEG monitoring will be necessary to localize the seizure focus often in conjunction with structural abnormalities detected by brain Magnetic resonance imaging (MRI) [23]
Ganglioglioma and dysembryoblastic neuroepithelial tumors (DNET), low grade neoplasms that are closely linked to dysplasias, are among the most common low-grade neoplasm identified in intractable pediatric epilepsy patients
Summary
Epilepsy is characterized by recurrent unprovoked seizures and has an estimated prevalence of about 5-15 per 1000 [1]. Even in the absence of concordant lesions on MRI, surgical resection of single foci detected by intracranial EEG (iEEG) often results in a good seizure outcome [6]. In most cases of neocortical epilepsy, intracranial EEG (iEEG) monitoring will be necessary to localize the seizure focus often in conjunction with structural abnormalities detected by brain MRI [23]. Ganglioglioma and dysembryoblastic neuroepithelial tumors (DNET), low grade neoplasms that are closely linked to dysplasias, are among the most common low-grade neoplasm identified in intractable pediatric epilepsy patients These tumors exhibit mixed histopathological features including proliferative astrocytes, dysmorphic neurons, and large cells of unclear cellular lineage known as atypical ganglion cells. The main contribution of the semiology is to aid in placement of the intracranial electrodes, but the semiology itself does not appear to determine the clinical outcome [41]
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