Abstracts

Rationale: The purpose of this case report is to describe a pediatric patient with right hemispheric multifocal polymicrogyria (PMG) who has been seizure free for four months after small focal resection.

Methods: Data including documentation, imaging and neurophysiology data pertinent to patient's hospital course and follow up visits collected and presented to highlight case and results.

Results: 22-month-old girl with known multifocal PMG involving right frontal, temporal and parietal lobes, infantile spasms, and refractory focal epilepsy on three anti-seizure medications (ASMs) presented with increased seizure frequency in setting of adenovirus infection. Her semiology was focal left clonic and/or tonic seizures primarily affecting the face and arm. During first few days of hospitalization, she was having multiple focal seizures per hour requiring multiple additions and loading doses of ASMs and initiation of pentobarbital infusion. Despite these interventions, seizures resumed and worsened after pentobarbital wean. Epilepsy surgery considered at 1 month after her admission. Seizure semiology was used to hypothesize localization of seizure onset zone to the right prefrontal cortex, more specifically involving the convexity rather than mesial structures. An alternative hypothesis of parieto-frontal onset was considered based on semiology. Seizure onset was noted in right frontal F4 lead on scalp electroencephalogram (EEG) suggesting seizure onset in the prefrontal/premotor areas with propagation to primary motor cortex. The patient underwent Electrocorticography (ECoG) guided resection of the right prefrontal and right lateral parietal regions. After surgery, she had seizures post-operatively in setting of fever but has since been seizure free with improved cognition and motor function and ability to wean off some of her ASMs.

Conclusions: This case highlights smaller resections may be effective even in patients with larger malformations since only a small portion of the malformation may be epileptogenic. In this particular case, seizure semiology, EEG and ECoG data were integrated to localize seizure onset zone and associated networks. Data adds to growing body of literature that supports smaller resections and more thoughtful surgical planning in patients with such malformations to prevent loss of function.

Reference:
1. Wang, D. D., Knox, R., Rolston, J. D., Englot, D. J., Barkovich, A. J., Tihan, T., Auguste, K. I., Knowlton, R. C., Cornes, S. B., & Chang, E. F. (2016). Surgical management of medically refractory epilepsy in patients with polymicrogyria. Epilepsia, 57(1), 151–161.

Funding: Please list any funding that was received in support of this abstract.: None.