Late-onset epileptic spasms may be cured by focal cortical resective surgery

Area of Science:

• Pediatric Neurology
• Epileptology
• Neurosurgery

Background:

• Epileptic spasms, particularly late-onset and isolated forms, can present diagnostic challenges.
• Pharmacoresistant seizures necessitate exploration of alternative treatment strategies.
• Identifying the precise seizure onset zone is crucial for effective surgical intervention.

Purpose of the Study:

• To report a case of isolated late-onset epileptic spasms successfully treated with focal frontal cortectomy.
• To illustrate the utility of advanced neuroimaging and electrophysiological techniques in localizing seizure origins.
• To demonstrate that surgical resection can be curative even without clear surface EEG localization.

Main Methods:

• Case report detailing a child with late-onset epileptic spasms.
• Utilized interictal and ictal video-EEG, MRI, FDG-PET, and PET-MRI co-recording.
• Performed SEEG (Stereoelectroencephalography) for detailed ictal discharge mapping.
• Conducted a tailored focal frontal resection.

Main Results:

• The child presented with pharmacoresistant, sleep-only epileptic spasms starting at age 2.
• MRI revealed a white matter abnormality in the left frontal superior gyrus.
• FDG-PET and PET-MRI confirmed localized cortical hypometabolism.
• SEEG identified localized discharge correlating with the MRI lesion.
• Post-focal frontal cortectomy, spasms significantly reduced (Engel class II).

Conclusions:

• Isolated late-onset epileptic spasms can be effectively treated with focal cortical resection.
• Advanced imaging (MRI, PET) and SEEG are vital for localizing seizure foci when surface EEG is inconclusive.
• Surgical intervention can lead to significant seizure reduction and improved outcomes in select cases.