Open Access
CC BY-NC-ND 4.0 · International Journal of Epilepsy 2023; 09(01/02): A1-A40
DOI: 10.1055/s-0044-1791453
E-Poster Abstracts

Double Trouble: Dual Pathology in Temporal Lobe Sclerosis and the Role of Stereo-electroencephalogram in Its Management

Autoren

  • Sidharth S.

    1   All India Institute of Medical Sciences, New Delhi, India

  • Manjari Tripathi

    1   All India Institute of Medical Sciences, New Delhi, India

  • P. Sarat Chandra

    1   All India Institute of Medical Sciences, New Delhi, India

  • Deepti Vibha

    1   All India Institute of Medical Sciences, New Delhi, India
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Introduction: Coexistence of temporal sclerosis with focal cortical dysplasia (FCD) in other site is difficult to treat. In cases of discordance between EEG and lesion, stereo-EEG may help in tackling the dual pathology.

Methodology: A 42-year-old female with drug refractory epilepsy, onset at 5 years of age with focal dyscognitive seizures was operated with left anterior temporal lobectomy and amygdalohippocampectomy (biopsy proven temporal sclerosis). She had presurgery seizure frequency of 5/week and postsurgery achieved Engelman 2. After 5 years of surgery, seizure frequency went to 5–6 per week and was evaluated: video-EEG showed F7T3 F8 localization, ictal SPECT: left temporal and frontal, PET: left lateral temporal lobe, MEG: left temporal, MRI brain: post-op changes in left temporal and left frontal FCD. ROSA-guided SEEG with placement of 11 electrodes in and around left frontal FCD was done with 5 in peri-FCD, 1 each in anterior, posterior, inferior to FCD, Broca's, amygdala, tail of hippocampus. Radiofrequency ablation of FCD was done after stimulation and localization. She achieved Engelman 1.

Discussion: Analysis in 240 patients of temporal lobe epilepsy (TLE) by Salanova et al showed 15.4% with dual pathology. Our case had achieved seizure freedom after surgical resection of temporal sclerosis. However, due to the manifestation of dual pathology in the form of frontal FCD, stereo-EEG helped in ablating the seizure focus.

Conclusion: Dual pathology may become challenging even after surgical resection in TLE. Stereo-EEG may guide to tackle the dual pathology after resection for ablation of the foci.



Publikationsverlauf

Artikel online veröffentlicht:
12. September 2024

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