Case MRI Negative Drug-resistant Epilepsy and Improved Seizure Control by Using Electroencephalography Source Imaging Analysis -guided Stereo-electroencephalography (SEEG) in Developing Country
Abstract number :
2.42
Submission category :
18. Case Studies
Year :
2023
Submission ID :
558
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Peeraya Wachiropathum, MD – Phramongkutklao hospital
Charcrin Nabangchang, MD – Phramongkutklao hospital; Siraruj Sakoolnamarka, MD – Phramongkutklao Hospital; Thitiwan Simasathien, MD – Phramongkutklao hospital; Piradee Suwanpakdee, MD – Pediatric – Phramongkutklao
Rationale:
Epilepsy surgery has been proven to be an effective treatment for patients with drug-resistant epilepsy. However, presurgical evaluation of nonlesional focal epilepsy can be very challenging. Recently, Electroencephalography Source Imaging Analysis has shown to be effective in localizing the epileptogenic zone even in cases whose MRI was negative. However, this approach is not yet widely used in developing countries due to its cost. We describe a case MRI negative drug-resistant epilepsy using Electroencephalography Source Imaging Analysis-guided Stereo-electroencephalography (SEEG) and improved seizure outcome.
Methods: Single case report
Results: A seven year old boy with MRI-negative drug-resistant epilepsy and developmental delay had an onset of epilepsy at three years of age. Multiple semiologies were noted such as blank staring, eye blinking, generalized tonic with right arm raised, and gelastic seizure with impaired awareness approximately two to three times per day. Despite multiple anti-seizure medications being prescribed with limitation by HLAB*1502 positive, his seizures still worsened. Brain MRI showed unremarkably. EEG demonstrated ictal onset arising from the bilateral frontal regions. EEG interictal revealed multifocal sharp waves from bilateral hemispheres. Brain SPECT showed no focal abnormality. PET Scan reported hypometabolism at the bilateral high anterior frontal, left frontal-parietal lobe, and left lateral temporal lobe. Next-generation sequencing showed PSEN1 gene mutation but classified as variants of uncertain significance (VUS). Despite the non-localize epileptogenic zone from many tests, the Electroencephalography source imaging analysis was performed with NeuroScan software CURRY V.9.0 using scalp EEG interictal and ictal epileptic activity data showed the possible seizure onset arising from the left frontal area. Stereo-EEG implantation was done and confirmed the epileptogenic zone from that particular region. Left superior and middle frontal gyrus resection was done. Pathology revealed FCD type IIA. After surgery, his seizures were markedly improved (Engel class II) as well as his quality of life.
Conclusions:
Electroencephalography source imaging analysis may consider a useful noninvasive presurgical evaluation in drug-resistant epilepsy patients with MRI negative or disconcordant presurgical evaluation data.
Funding: None
Case Studies