Abstracts

Rationale: Epilepsy surgery is rarely performed in patients with perisylvian polymicrogyria due to concerns regarding the precise determination of epileptogenic zone. We report a patient with unilateral perisylvian polymicrogyria who underwent surgery after stereo-EEG (SEEG), and has remained seizure free. Methods: Case report Results: A 44 year old right handed woman presented with pharmacoresistant focal seizures with onset at age 25. Brain MRI showed right perisylvian polymicrogyria (PSPMG) and mildly decreased volume of the right temporal lobe without signs of mesial temporal sclerosis. In 2011, she underwent noninvasive video-EEG monitoring, which captured three typical seizures with features suggestive of right temporal onset including ictal speech, preserved responsiveness, right sided automatisms with mild left hand dystonia. Ictal EEG onset was in the right hemisphere with the most prominent changes in the right temporal region. Interictal EEG showed right temporal sharp waves. She underwent SEEG with nine intracerebral depth electrodes in 2012. Seven seizures (five simple partial, two complex partial) were recorded. Ictal onset was in the right anterior hippocampus, posterior hippocampus, amygdala and orbital frontal regions as well as periopercular and insular regions. FDG-PET scan showed mildly decreased tracer uptake in the right temporal region. She underwent a right temporal lobectomy and resection of the frontal operculum along with intraoperative electrocorticography in December 2014. She has remained seizure free since her surgery and reported a significant improvement in her quality of life. Conclusions: Epilepsy surgery can be performed in PSPMG if the clinical semiology, MRI findings, EEG characteristics, PET scan findings are concordant. SEEG is useful to study the relationship between the epileptic focus and the lesion, and to plan the extent of resection. Funding: None