How small can the epileptogenic region be? A case in point
Graeme D Jackson1, Mangor Pedersen2, A Simon Harvey2
1From The Florey Institute of Neuroscience and Mental Health (G.D.J., M.P.), The University of Melbourne; Department of Neurology (G.D.J.), Austin Health; and Department of Neurology (A.S.H.), Royal Children's Hospital, Melbourne, Australia. g.jackson@brain.org.au.
Neurology
|April 28, 2017
Summary
A small, functionally abnormal brain region can cause severe epilepsy and disrupt brain networks. Surgical removal of this focal area led to seizure freedom and normalized brain network function.
Area of Science:
- Neuroscience
- Epileptology
- Functional Neuroimaging
Background:
- Intractable epilepsy can be challenging to localize and treat.
- Understanding the role of localized cortical dysfunction in epilepsy is crucial.
Observation:
- A patient with intractable epilepsy exhibited abnormal local connectivity in a small cortical region.
- Novel functional MRI techniques, regional homogeneity and small-worldness, identified this focal abnormality.
Findings:
- Surgical resection of the small (13x7x6 mm) epileptogenic zone in the supramarginal gyrus resulted in sustained seizure freedom.
- Post-surgery, whole-brain network characteristics normalized, indicating restored brain network integration and segregation.
Implications:
- This case highlights that highly epileptogenic small cortical areas can drive intractable epilepsy.
- Focal cortical abnormalities can significantly disrupt large-scale brain networks involved in cognition.
- Precise localization of epileptogenic zones using advanced neuroimaging is key for effective epilepsy treatment.
