Inferior parietal lobule gyrations in refractory epilepsy

Area of Science:

• Neurology
• Neuroimaging
• Epileptology

Background:

• Posterior parietal epilepsy presents diagnostic challenges due to complex symptoms and non-localizing electrophysiological data.
• The inferior parietal lobule (IPL) can display normal gyral variations, potentially masking refractory, surgically remediable epilepsies.

Observation:

• This case series details four patients with refractory parietal epilepsy.
• All patients underwent comprehensive presurgical evaluation, including 3T MRI with volumetric T1, FLAIR, and T2 SPACE sequences.
• IPL gyral variation was observed in association with dysplasia, histopathologically confirmed in three patients.

Findings:

• Subtle gyral variations in the inferior parietal lobule (IPL) can be associated with focal cortical dysplasia.
• Volumetric brain MRI, particularly sagittal plane interpretation, is crucial for identifying these subtle anomalies.
• These cases of refractory epilepsy may be more prevalent than currently recognized.

Implications:

• Increased awareness of IPL gyral variations and associated dysplasia is essential for accurate diagnosis.
• Understanding foetal development of the sylvian fissure and operculisation aids in recognizing these epilepsy subtypes.
• Improved diagnostic approaches can lead to better surgical outcomes for patients with refractory parietal epilepsy.