Stereo-EEG tailored resection in a child with presumed perinatal post-stroke epilepsy: The complex organization of epileptogenic zone

• Published in: Epilepsy & behavior reports Vol. 23; p. 100616
• Main Authors: Chiarello, D., Tumminelli, G., Sandrin, F., Vilasi, C., Castana, L., Lo Russo, G., Liava, A., Francione, S.
• Format: Journal Article
• Language: English
• Published: Elsevier 01-01-2023
• Subjects: Epileptogenic zone; Functional damage; Perilesional area; Post-stroke epilepsy; Tailored SEEG surgery
• ISSN: 2589-9864; 2589-9864
• DOI: 10.1016/j.ebr.2023.100616

IntroductionOnly a few studies have focused on tailored resection in post-stroke epilepsy, in which hemispherectomy and hemispherotomy are the most recognized treatments. Case descriptionWe 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 conclusionThe 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.