Stereotactic cortical resection in non-lesional extra-temporal partial epilepsy.
The presentation and treatment of a patient with extra-temporal non-lesional partial epilepsy is discussed herein. His clinical semiology was consistent with supplementary motor area seizures; however, MR imaging did not demonstrate a lesion. A region of stable cortical glucose hypermetabolism in the left frontal region was noted with 2-fluoro-2-deoxy-D-glucose (FDG)-PET. This was consistent with the frequent interictal discharges evident over the left fronto-temporal region and the stereotypic high amplitude ictal discharges arising with highest amplitude from the left frontal region. Epileptiform activity evident on an intracranial 64-point subdural recording grid placed over the left dorsolateral frontal cortex confirmed a distribution concordant with FDG-PET findings. The subsequent resection was guided by the PET and EEG findings rather than structural MR imaging, and a limited cortical resection led to an immediate and substantial reduction in seizure frequency.
Shields
D C
DC
Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Costello
D J
DJ
Gale
J T
JT
Hoch
D B
DB
Eskandar
E N
EN
D000328:Adult; D002540:Cerebral Cortex / Q000502:physiology / Q000601:surgery*; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods; D004828:Epilepsies, Partial / Q000503:physiopathology / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D013238:Stereotaxic Techniques / Q000295:instrumentation