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[An operated case of medial temporal lobe epilepsy associated with schizencephaly]
T Morioka1, S Nishio, K Hisada
1Departments of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Abstract:
A 24-year-old male of medial temporal lobe epilepsy associated with schizencephaly was presented. He developed complex partial seizure after head trauma at the age of a year and 7 months, which became intractable at the age of 13 year. MRI demonstrated a schizencephalic cleft in the right peri-Rolandic area, cortical dysplasia in the right medical parietal and occipital lobes, and right hippocampal atrophy. Scalp-recorded EEG failed to localize the ictal onset zone. Interictal FDG-PET and ECD-SPECT indicated hypometabolism and hypoperfusion of the right entire temporal lobe, and ictal ECD-SPECT increased perfusion of this area. Chronic subdural electrode recording clearly demonstrated that ictal onset zone was located not on the schizencephalic cleft or its surrounding cortex but on the right medial temporal lobe. Following right anterior temporal lobectomy with hipppocampectomy, seizure control became easy. For the identification of the epileptogenic zone in patients with schizencephaly, chronic subdural electrode recording is mandatory.
Insights
This study highlights a case of medically intractable epilepsy in a patient with schizencephaly. Chronic subdural electrode recording proved essential for identifying the seizure focus in the medial temporal lobe, enabling successful surgical treatment.
Area of Science:
- Neuroscience
- Epileptology
- Neuroradiology
Background:
- Medial temporal lobe epilepsy (MTLE) can be associated with structural brain abnormalities like schizencephaly.
- Identifying the precise epileptogenic zone is crucial for effective surgical management of intractable epilepsy.
Observation:
- A 24-year-old male with medically intractable complex partial seizures presented with schizencephaly and right peri-Rolandic cortical dysplasia.
- Magnetic Resonance Imaging (MRI) revealed a schizencephalic cleft, cortical dysplasia, and right hippocampal atrophy.
- Scalp electroencephalography (EEG) and functional imaging (FDG-PET, ECD-SPECT) provided inconclusive localization of the ictal onset zone.
Findings:
- Chronic subdural electrode recording definitively localized the ictal onset zone to the right medial temporal lobe, distinct from the schizencephalic cleft.
- Ictal single-photon emission computed tomography (SPECT) showed increased perfusion in the right temporal lobe, correlating with the seizure focus.
Implications:
- Chronic subdural electrode recording is a mandatory and highly effective method for identifying the epileptogenic zone in epilepsy patients with schizencephaly.
- Surgical resection, specifically right anterior temporal lobectomy with hippocampectomy, resulted in improved seizure control for this patient.
- This case underscores the importance of advanced invasive monitoring when non-invasive methods fail to delineate the seizure origin in complex structural epilepsy.