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

Area of Science:

• Neurology
• Epileptology
• Neuroimaging

Background:

• Partial epilepsy can present challenges when structural Magnetic Resonance (MR) imaging reveals no identifiable lesion.
• Supplementary motor area seizures may exhibit specific clinical semiology.
• Accurate localization is crucial for effective surgical intervention in refractory epilepsy.

Observation:

• A patient with extra-temporal non-lesional partial epilepsy showed clinical signs suggestive of supplementary motor area seizures.
• Despite negative MR imaging, 2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) revealed stable cortical glucose hypermetabolism in the left frontal region.
• Intracranial electroencephalography (EEG) confirmed epileptiform activity localized to the left dorsolateral frontal cortex, correlating with FDG-PET findings.

Findings:

• FDG-PET and intracranial EEG provided concordant localization of the seizure focus in the left frontal cortex.
• Surgical resection guided by functional neuroimaging (FDG-PET) and EEG, rather than solely structural MR imaging, was performed.
• The patient experienced an immediate and significant reduction in seizure frequency post-resection.

Implications:

• Functional neuroimaging like FDG-PET can be invaluable in localizing seizure foci in non-lesional epilepsy.
• Integrating FDG-PET and EEG data can guide epilepsy surgery effectively, even in the absence of structural abnormalities.
• This case highlights the potential for successful surgical outcomes in challenging epilepsy cases through advanced diagnostic techniques.