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Heterotopia or overlaying cortex: What about in-between?
Emilija Cvetkovska1,2, William Alves Martins1,3, Jorge Gonzalez-Martinez1,4
1Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Epilepsy & Behavior Case Reports
|November 21, 2018
Summary
Periventricular nodular heterotopia (PNH) can cause drug-resistant epilepsy. Laser ablation of PNH and white matter "micronodules" successfully treated a patient, highlighting new epilepsy targets.
Area of Science:
- Neuroscience
- Epileptology
- Neurosurgery
Background:
- Periventricular nodular heterotopia (PNH) is a malformation of cortical development associated with epilepsy.
- Drug-resistant epilepsy poses significant challenges in patient management.
- Understanding the precise epileptogenic networks in PNH is crucial for effective treatment.
Observation:
- A patient with unilateral PNH and intractable epilepsy underwent stereo-EEG (SEEG).
- SEEG revealed seizure onset originating from the PNH, with rapid involvement of adjacent white matter "micronodules" and overlying cortex.
- These findings suggest a complex epileptogenic network extending beyond the main heterotopic nodule.
Findings:
- The study identified "micronodules" of heterotopic neurons in the white matter as potential contributors to epileptogenicity.
- Laser ablation targeting both the PNH and these white matter micronodules was performed.
- The patient became seizure-free following the minimally invasive surgical procedure.
Implications:
- This case suggests that white matter "micronodules" associated with PNH can play a significant role in seizure generation.
- Identifying and targeting these specific epileptogenic zones offers a novel therapeutic strategy.
- Minimally invasive procedures targeting patient-specific epileptic networks in heterotopia show promise for seizure control.
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