Stereotactic laser ablation for nonlesional cingulate epilepsy: case report.
Ahmad Marashly1, Michelle M Loman2, Sean M Lew2
1Divisions of1Pediatric Neurology.
Journal of Neurosurgery. Pediatrics
|August 4, 2018
Summary
Stereotactic laser ablation (SLA) successfully treated a patient with drug-resistant epilepsy originating in the extratemporal lobe. This minimally invasive procedure, guided by stereoelectroencephalography (SEEG), achieved seizure freedom without neurological deficits.
Area of Science:
- Neurosurgery
- Epileptology
- Neurology
Background:
- Stereotactic laser ablation (SLA) is an emerging treatment for refractory focal epilepsy.
- While effective for mesial temporal lobe epilepsy, its use in extratemporal epilepsy is less established.
Observation:
- A 17-year-old male presented with refractory nocturnal seizures, suspected to originate near the supplementary sensory motor area.
- Non-invasive investigations, including EEG and MRI, failed to localize the seizure onset zone.
- Bilateral stereoelectroencephalography (SEEG) identified the seizure origin in the right midcingulate gyrus, adjacent to eloquent motor areas.
Findings:
- SLA targeting the right midcingulate gyrus resulted in complete seizure freedom immediately post-procedure.
- The patient experienced no postoperative neurological deficits during a 17-month follow-up period.
Implications:
- This case demonstrates the efficacy of SLA for nonlesional, extratemporal focal epilepsy.
- Stereoelectroencephalography (SEEG) is crucial for localizing difficult-to-diagnose seizure onset zones in complex epilepsy cases.
- SLA offers a viable treatment option for epilepsy outside the temporal lobe, expanding its therapeutic applications.
Keywords:
AED = antiepileptic drugHH = hypothalamic hamartomaMTLE = mesial temporal lobe epilepsySEEG = stereoelectroencephalographySLA = stereotactic laser ablationSOZ = seizure onset zoneSSMA = supplementary sensory motor areacingulate gyrusepilepsylaser interstitial thermal ablationstereotactic laser ablationsurgery
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