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Updated: Jul 17, 2026
Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
Ictal phase-amplitude coupling supports surgical decision-making in MRI-negative epilepsy with non-localizing SEEG:
Kazuki Nishioka1,2, Hiroharu Suzuki3,4, Takumi Mitsuhashi1,2
1Department of Neurosurgery, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 1138421, Japan.
Abstract:
We report a 14-year-old boy with MRI-negative drug-resistant frontal lobe epilepsy presenting with the chapeau de gendarme sign. SEEG showed diffuse low-voltage fast activity with rapid bilateral propagation, precluding reliable visual localization. Ictal phase-amplitude coupling (PAC) analysis revealed a right-dominant increase in modulation index at seizure onset, localizing to the anterior insula and adjacent prefrontal cortex. Informed by these findings, right frontal disconnection with operculo-insular resection was performed, resulting in seizure freedom at 1 year. This case highlights the utility of ictal PAC analysis in guiding surgical decision-making when SEEG findings are non-localizing.
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