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Updated: Jul 18, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Stereo-EEG tailored resection in a child with presumed perinatal post-stroke epilepsy: The complex organization of
D Chiarello1, G Tumminelli2, F Sandrin1
1"Claudio Munari" Epilepsy Surgery Center, GOM Niguarda, Milano, Italy.
Insights
Tailored epilepsy surgery using SEEG-guided interventions improved outcomes for a patient with drug-resistant post-stroke epilepsy. This approach precisely targeted the epileptogenic zone, leading to seizure control without worsening neurological deficits.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Post-stroke epilepsy presents treatment challenges, with limited research on tailored resection strategies.
- Hemispherectomy and hemispherotomy are established but not universally applicable treatments.
Purpose of the Study:
- To describe a case of drug-resistant post-stroke epilepsy managed with a tailored surgical approach.
- To evaluate the efficacy of SEEG-guided interventions in localizing and treating the epileptogenic zone.
Main Methods:
- Stereoelectroencephalography (SEEG) was employed to investigate discordant anatomical, electrophysiological, and clinical findings.
- A combined surgical strategy involving SEEG-guided radiofrequency thermocoagulation and resective surgery was performed.
- Interventions targeted the identified fronto-mesial and central opercular regions.
Main Results:
- SEEG successfully localized the epileptogenic zone, distinct from but connected to the anatomical lesion.
- The combined surgical approach resulted in good seizure control (Engel Ib classification).
- No additional neurological deficits were observed post-operatively.
Conclusions:
- Tailored, SEEG-guided surgical interventions can effectively manage drug-resistant post-stroke epilepsy.
- This approach offers a precise method for identifying and treating the epileptogenic zone, improving patient outcomes.
- Personalized surgical strategies are crucial for optimizing results in complex epilepsy cases.
Introduction:
Only a few studies have focused on tailored resection in post-stroke epilepsy, in which hemispherectomy and hemispherotomy are the most recognized treatments.
Case Description:
We describe the case of a patient with drug-resistant, presumed perinatal, post-stroke epilepsy and moderate right hemiparesis. The seizures were stereotyped, both spontaneous and induced by sudden noises and somatosensory stimuli. Considering the discordant anatomic-electro-clinical data - left perisylvian malacic lesion with electrical onset over the left mesial fronto-central leads - and the patient's functional preservation, SEEG was performed. SEEG revealed sub-continuous abnormalities in the perilesional regions. Several seizures were recorded, with onset over the premotor area, rapidly involving the motor and insular-opercular regions. We decided for a combined surgical approach, SEEG-guided radiofrequency thermocoagulation, on the fronto-mesial structure but also on the central operculum, followed by resective surgery including only the fronto-mesial structures.
Discussion And Conclusion:
The SEEG allowed to localize the epileptogenic zone far away from the anatomical lesion but connected to part of it. A combined surgical approach tailored on SEEG results allowed a good outcome (Engel Ib) without additional deficits.
