Abstracts

Rationale: To describe the feasibility, safety and seizure outcome of patients with medically intractable rolandic epilepsy who underwent staged resections guided by multimodal extra and intraoperative SEEG recordings. Methods: From January 2015 through January 2017, data related to semiology, non-invasive electrophysiology, imaging, neuropsychology, intra and extra-operative invasive monitoring, type of resection, complications, surgical pathology results and seizure outcome were retrospectively collected and analyzed. The research was approved by IRB. Results: Patient 1 is a 35-month-old boy with daily seizures:subtle left hand and bilateral shoulders jerk with mild left hand neglect. All the pre-surgical data pointed toward the right rolandic region. EEG electrodes targed the pre and postcentral gyrus, the pre-motor and parietal region. Extraoperative sEEG data showed synchronous epileptiform discharge at the right motor hand knob region synchronous with spike activity in the superior parietal lobule and supplementary motor (SMA) regions.Patient 2 is a 15-year-old girl with daily seizures:tightness around the left knee followed by left thigh/feet clonic. All the pre-surgical data pointed toward right paracentral lobule. Extraoperative sEEG data showed frequent epileptiform spike activity in precentral gyrus of paracentral lobule motor cortex synchronous with spike activity in motor hand knob and SMA.Patient 3 is a 18-year-old girl with daily seizures:left hand numbness followed by left arm or head clonic or axial tonic. All the pre-surgical data pointed toward right precentral gyrus around the hand/shoulder region. Extraoperative sEEG data showed synchronous epileptiform activity at SMA, motor hand and face regions.  Patient 4 is a 15-year-old- girl with daily seizures: left leg somatosensory aura followed by clonic activity with postictal weakness. All the presurgical data pointed toward right rolandic cortex. Extraoperative sEEG data showed synchronous epileptiform activity at paracentral motor cortex synchronous with spike activity in premotor cortex and SMA. In all patients, MRIs were considered non-lesional and continuous intraoperative sEEG recording combined with subdural Grid were recorded. Stage resection approach was performed at exact epileptic electrodes guided by real-time intraoperative sEEG data. In first patient, hand knob sensory cortex was resected with complete resolution of spike activity. No motor deficit was appreciated and patient is seizure free for one year. Pathology showed focal cortical dysplasia typeIIA with presence of nodular heterotopia in subcortical white matter. In second patient, stage resection of exact spiking electrode at paracentral lobule region was performed with continuous clinical examination of the left leg strength. Patient was seizure free and had mild foot drop after 2 years. Pathology showed possibility of vascular malformation. In third patient, superior and inferior bank of the superior frontal sulcus resection was followed by resection of mid-cingulate and SMA with complete resolution of polyspikes activity. Patient was seizure free for one year without any weakness. In fourth patient, premotor and part of SMA was resected and complete resolution of spike activity. Only mild motor deficit was appreciated and patient was seizure free since surgery one month ago. Conclusions: The results of this highly selected group of patients testify for the feasibility and safety of a novel multimodal method of invasive monitoring, combining the benefits of both intra and extra-operative SEEG recordings. Funding: None