title: Successful hemispherotomy for a patient with intractable epilepsy secondary to bilateral congenital brain malformation with lateralized pyramidal tract of diffusion tensor image tractography.
abstract: OBJECTIVE
  To perform an epilepsy surgery on a patient with drug resistant epilepsy secondary to bilateral brain malformation. The patient was a 2-year 9-month-old boy who had congenital bilateral multiple abnormalities. He developed a complex partial seizure at 9 months old. Based on the presurgical evaluations, he underwent a right hemispherotomy.
  
  
  RESULTS
  Brain MRI revealed congenital bilateral polymicrogyria, right schizencephaly, and corpus callosum agenesis. The abnormality was noted to be more severe in the right hemisphere. Diffusion tensor image tractography clearly detected a left pyramidal tract. On the contrary, the right hemisphere did not show a clear pyramidal tract. An interictal EEG showed epileptiform discharges over both hemispheres with right frontotemporal area dominancy. The long-term video-EEG recorded his habitual seizures arising from the right frontal area. Right hemispherotomy led to freedom from seizures and a reduced need for anti-epilepsy drugs.
  
  
  CONCLUSIONS
  We report a patient with bilateral MRI and EEG abnormalities with clear DTI laterality who achieved seizure freedom with epilepsy surgery.
authors.affiliation: Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Nagai
authors.affiliation: Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
authors.forename: Ayataka
authors.initials: A
authors.lastname: Fujimoto
authors.affiliation: Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Okanishi
authors.affiliation: Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
authors.forename: Hironao
authors.initials: H
authors.lastname: Motoi
authors.affiliation: Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
authors.forename: Sotaro
authors.initials: S
authors.lastname: Kanai
authors.affiliation: Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yokota
authors.affiliation: Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Enoki
authors.affiliation: Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
authors.forename: Mitsuyo
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Seirei Hamamatsu General Hospital, Comprehensive Epilepsy Center, Japan.
authors.forename: Takamichi
authors.initials: T
authors.lastname: Yamamoto
keywords: Bilateral congenital brain malformation; Brain magnetic resonance imaging (MRI); Diffusion tensor image (DTI) tractography; Epilepsy surgery; Hemispherotomy