[P2-65] First SEEG - guided Surgery in Multilesional Epilepsies in Thailand: A Pediatric Case Report
Multilesional epilepsies are defined by involvement of more than one epileptogenic lesions in one or both hemispheres. In this particular group, the patients often have medically intractable epilepsy and poor quality of life. Typically, they were considered nonsurgical candidates, therefore the indication of surgery and seizure outcome are still difficult to determine. However, recent studies have demonstrated case using Stereo-electroencephalography (SEEG) followed by surgical resection with good seizure outcome.
We report a 7-year-old right-handed girl, with seizure onset at 4 months of age. Despite adequate medication trials, she still has had many daily seizures. In 2012, she underwent subdural grid implantation followed by right parieto-occipital resection. Histopathology showed cortical dysplasia. Her seizures continued after surgery with same semiology but decreased intensity. Re-evaluation was performed. MRI showed cortical dysplasia in the left posterior cortex. EEG seizures were arising from left and right parieto-occipital regions. We decided to explore with SEEG technique focusing on bilateral posterior cortex coverage. The result from SEEG indicated two independent epileptogenic zone. Tailored resection was based on SEEG analysis resulting in Engel class II outcome with significant improvement of quality of life. Histopathology also confirmed the evidence of cortical dysplasia.
This case demonstrates that the presence of multilesional epilepsies should not necessarily be a contraindication to epilepsy surgery. In addition, SEEG has the advantages of extensive bihemispheric explorations with minimal morbidity. Our patient’s outcome is encouraging to use this tool to explore surgery for this challenging group.
We report a 7-year-old right-handed girl, with seizure onset at 4 months of age. Despite adequate medication trials, she still has had many daily seizures. In 2012, she underwent subdural grid implantation followed by right parieto-occipital resection. Histopathology showed cortical dysplasia. Her seizures continued after surgery with same semiology but decreased intensity. Re-evaluation was performed. MRI showed cortical dysplasia in the left posterior cortex. EEG seizures were arising from left and right parieto-occipital regions. We decided to explore with SEEG technique focusing on bilateral posterior cortex coverage. The result from SEEG indicated two independent epileptogenic zone. Tailored resection was based on SEEG analysis resulting in Engel class II outcome with significant improvement of quality of life. Histopathology also confirmed the evidence of cortical dysplasia.
This case demonstrates that the presence of multilesional epilepsies should not necessarily be a contraindication to epilepsy surgery. In addition, SEEG has the advantages of extensive bihemispheric explorations with minimal morbidity. Our patient’s outcome is encouraging to use this tool to explore surgery for this challenging group.