Abstracts

RATIONALE: SPA represents an anatomical variation rarely associated with refractory epilepsy (RE). It may be associated with other midline abnormalities such as hypothalamic dysfunctions, optic tract athrophy etc. This study report patients with RE and SPA submitted to surgery. METHODS: Patient I, a 26 year-old man had left simple partial motor seizures since the age of 3. They were refractory and occurred frequently during the day. Interictal EEG showed right frontoparietal spiking. Ictal EEG was not localizatory. MRI showed SPA and two distinct areas of cortical dysplasia: one over the cingulate gyrus and other in the premotor area. Patient II had right simple visual and complex partial seizures with automatisms since the age of 5. Seizures occurred at a frequency of 1/week. MRI showed SPA. Interictal EEG showed diffuse spiking over the left hemisphere. Ictal EEG was not localizatory. RESULTS: Patient I was submitted to subdural grids' implantation and eloquent cortex mapping. An extensive right frontal lobe resection was carried out. He has been seizure-free since surgery. There were no immediate postoperative seizures. Patient II was submitted to subdural implantation of the left posterior quadrant and a left temporo-occipital resection was carried out afterwards. The surgical specimen disclosed a 4 mm area of cortical dysplasia. He has been seizure-free since surgery. There were no immediate postoperative seizures. CONCLUSIONS: SPA is rarely associated with RE. Only a small number of such patients have been described. There might be an association of SPA and cortical disgenesis. SPA resembles an enlarged single ventricle on MRI. On the other hand, none of the patients described here had immediate postoperative seizures, which are extremely common in patients with true non-hypertensive hydrocephalus.