AI Summary & Key Takeaways
AI InsightWe want to re-emphasize that each patient with cortical dysplasia who is a candidate for epilepsy surgery should undergo detailed neuroradiological investigations as well as EEG monitorization, whereas complete resection of the lesion on the basis of findings that are obtained from neuroradiological examination might have a superior effect on the postoperative seizure outcome compared to the findings obtained from EEG recordings.
📌 3 Key Takeaways
Abstract
We report an 18-year-old boy who presented with seizures at the age of 12 years. He had 3 different kinds of seizures, occurring 4 to 5 times a week, despite adequate antiepileptic treatment. Magnetic resonance imaging (MRI) showed deep paramedian focal cortical dysplasia in the left parietal lobe. Ictal video-EEG demonstrated 5 seizures originating from the left parietal lobe, left hemisphere and right hemisphere. He was submitted to invasive recordings with two frontal strips and an interhemispherical grid that was advanced to the corpus callosum. The lesion and other seizure focuses were resected subpially down to the corpus callosum approximately 1 cm posterior to the motor area. His seizures resumed after three years of quiescence. Postoperative MRI investigation revealed remnants of dysplastic tissue deep in the interhemispheric region, which were silent during the invasive EEG monitorization. We want to re-emphasize that each patient with cortical dysplasia who is a candidate for epilepsy surgery should undergo detailed neuroradiological investigations as well as EEG monitorization, whereas complete resection of the lesion on the basis of findings that are obtained from neuroradiological examination might have a superior effect on the postoperative seizure outcome compared to the findings obtained from EEG recordings.
Özet
Biz bu yazıda 18 yaşında olan ve 12 yaşından bu yana nöbet geçiren erkek hastayı sunduk. Yeterli dozda ve sürede uygulanan antiepileptik ilaçlara rağmen haftada 4-5 kez olmak üzere 3 farklı tipte epileptik nöbetleri devam etmekteydi. Kranial MRI'da sol parietal derin paramedian yerleşimli fokal kortikal displazi alanı görüldü. İktal video EEG monitorizasyonunda sol parietal,sol ve sağ hemisfer kaynaklı 5 adet nöbet kaydedildi. Hastaya 2 frontal strip ve korpus kallosuma kadar uzanan interhemisferik grid elektrod yerleştirilerek invaziv EEG kayıtları elde edildi. Lezyon diğer epileptik odaklarla birlikte motor alanın 1 cm. posteriorundan subpial olarak rezeke edildi.Hasta postoperatif dönemde 3 yıl nöbet geçirmedi. 3 yılın sonunda nöbetleri yeniden başlayan hastanın yapılan MRI tetkikinde derin interhemisferik yerleşimli, daha önceki EEG monitorizasyonunda sessiz olan displastik doku artıkları gözlendi. Bu yazıda, epilepsi cerrahisi adayı olan fokal kortikal displazi vakalarında etkin postoperatif nöbet kontrolu için ayrıntılı nöroradyolojik incelemelerle belirlenen lezyon rezeksiyonunun, EEG monitorizasyonu ile belirlenen epileptojenik doku eksizyonundan daha effektif olduğu vurgulanmak istendi.