Stereotactic cortical resection in non-lesional extra-temporal partial epilepsy

Authors: Shields, D. C.¹; Costello, D. J.²; Gale, J. T.¹; Hoch, D. B.²; Eskandar, E. N.¹

Source: European Journal of Neurology, Volume 14, Number 10, October 2007 , pp. 1186-1188(3)

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Abstract:

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.

Keywords: epilepsy surgery; epileptogenic zone; extra-temporal epilepsy; non-lesional epilepsy; partial seizure

Document Type: Short communication

DOI: http://dx.doi.org/10.1111/j.1468-1331.2007.01920.x

Affiliations: 1: Departments of Neurosurgery 2: Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

Publication date: 2007-10-01