title: Stereo-EEG-guided radio-frequency thermocoagulations of epileptogenic grey-matter nodular heterotopy.
abstract: OBJECTIVE
  To retrospectively evaluate seizure outcome in a case-series of patients with nodular heterotopy (NH)-related epilepsy treated by stereo-EEG (SEEG)-guided radio-frequency thermocoagulation (RF-THC) of the NH.
  
  
  METHODS
  Five patients (three male, age 5-33 years) with drug-resistant focal epilepsy presented a single NH at brain MRI. Following video-EEG monitoring, patients underwent SEEG recording to better identify the epileptogenic zone. All patients received RF-THC of the NH, using contiguous contacts of the electrodes employed for recording. The contacts for RF-THC lesions were chosen according to anatomical (intranodular position) and electrical (intranodular ictal low-voltage fast activity) criteria.
  
  
  RESULTS
  At SEEG recordings, ictal discharge originated from the NH alone in three cases and from the NH and ipsilateral hippocampus in one case. In the remaining case, different sites of ictal onset, including the NH, were identified within the left frontal lobe. No adverse effects related to the RF-THC procedures were observed, apart from a habitual seizure that occurred during coagulation in one patient. Postprocedural sustained seizure freedom was detected in four cases (mean follow-up 33.5 months). In the case with left frontal multifocal ictal activity, RF-THC of the NH provided no benefit on seizures, and the patient is seizure-free after left frontal lobe resection.
  
  
  CONCLUSIONS
  SEEG-guided RF-THC proved to be a safe and effective option in our small case-series of NH-related focal epilepsy. The indications to this treatment were strictly dependent on findings of intracerebral recording by SEEG, which can define the role of the NH in the generation of the ictal discharge.
authors.affiliation: Department of Neurosciences, 'C. Munari' Epilepsy Surgery Centre, Ospedale Niguarda Ca' Granda, , Milano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Cossu
authors.forename: Dalila
authors.initials: D
authors.lastname: Fuschillo
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardinale
authors.forename: Laura
authors.initials: L
authors.lastname: Castana
authors.forename: Stefano
authors.initials: S
authors.lastname: Francione
authors.forename: Lino
authors.initials: L
authors.lastname: Nobili
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lo Russo
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000503:physiopathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004564:Electrocoagulation / Q000379:methods*; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000601:surgery; D006801:Humans; D008297:Male; D011846:Radio Waves; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D016896:Treatment Outcome
keywords: EEG; EPILEPSY; EPILEPSY, SURGERY; MRI; STEREOTAXIC SURGERY