Combining advanced neuroimaging techniques in presurgical workup of non-lesional intractable epilepsy.
OBJECTIVE
The rationale for this case report is to assess the degree of congruency between the results of several advanced functional, metabolic, and structural neuroimaging techniques used in patients with MRI-negative focal epilepsy.


METHODS
We investigated the presurgical evaluation and post-operative outcome of a patient with intractable, extratemporal epilepsy. Because the habitual seizures in this patient could be easily induced, six, advanced, neurodiagnostic techniques were successively applied (SISCOM, ictal FDG-PET, ictal fMRI, postictal diffusion-weighted imaging, voxel-based morphometry, and MRS imaging).


RESULTS
The findings for the neuroimaging methods investigated, within the left central region, were fairly congruent. Subsequent, invasive EEG recordings revealed a seizure-onset zone at the site where most of the neuroimaging had shown abnormal findings. The surgical removal of the epileptogenic zone, as defined by concordant neuroimaging and SEEG data, resulted in seizure-free postoperative outcome. Histopathological findings revealed mild focal cortical dysplasia.


CONCLUSIONS
Great efforts should be made to combine most of the advanced neuroimaging methods in the preoperative assessment of non-lesional epilepsy surgery candidates.
Brázdil
Milan
M
Department of Neurology, Brno Epilepsy Center, Czech Republic. mbrazd@med.muni.cz
Mikl
Michal
M
Chlebus
Pavel
P
Pazourková
Marta
M
Novák
Zdenek
Z
Chrastina
Jan
J
Prásek
Jirí
J
Bolcák
Karol
K
Fojtíková
Dagmar
D
Horký
Jaroslav
J
Tomcík
Jan
J
Lzicarová
Eva
E
Rektor
Ivan
I
D000328:Adult; D003952:Diagnostic Imaging; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18