Converting ‘non-lesional’ Imaging-occult Epilepsy into a Focal Lesional Entity Using Advanced Imaging Techniques
Abstract number :
1.174
Submission category :
18. Case Studies
Year :
2024
Submission ID :
820
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Muhammad Usman Khalid, MBBS – University of Kentucky
Flavius Raslau, MD – University of Kentucky
Valentinos Zachariou, PhD – University of Kentucky
David Powell, PhD – University of Kentucky
Ryan Cloyd, MD – Indiana University
Sarah H. Thomas, MD – University of Kentucky
John Kuipers, DO – University of Kentucky
Riham El Khouli, MD PhD – University of Kentucky
Timothy Ainger, PhD – University of Kentucky
Sally Mathias, MD – University of Kentucky
Farhan A. Mirza, MD – University of Kentucky
Rationale:
Refractory epilepsy is amenable to a variety of surgical treatments. To choose the best treatment method and achieve the best possible outcome, the seizure onset zone and network must be accurately identified prior to treatment.
Methods:
Clinical notes were reviewed in the electronic health system and commentary was provided by the operating surgeon, radiologist, and neurologists. BrainLab was used to visualize the SEEG placement.
Results:
Our patient was a 38-year-old man with a 14-year history of seizures. The seizures were initially tonic clonic in nature but changed to focal seizures with anti-epileptic drugs (AEDs). Seizure frequency was two to three per month and refractory to several AEDs. Initial investigation with scalp EEG, MRI, PET, ictal SPECT, MEG and SEEG did not provide conclusive seizure onset zone localization. Patient was then included in our ongoing study of post ictal ASL-MRI. Using these results, the original MRI was reviewed, texture and morphometric analyses (MAP) were performed, and these results were reviewed with emphasis on the patient’s semiology. A subtle focal cortical dysplasia (FCD) at the junction of the anterior bank of the right precentral gyrus and the precentral sulcus was identified, confirmed with repeat SEEG, and then safely resected without any functional deficits. Patient is now seizure free at one year.
Conclusions:
Arterial Spin Labeling (ASL)-MRI, in conjunction with other imaging modalities SEEG can aid in identification of seemingly occult epileptogenic foci. Concordant findings between multiple modalities should be key in pre-surgical evaluation and decision making. Retrospective evaluation of the structural MRI in light of new data should be a key step undertaken in every review of the patient’s story.
Funding: No funding was required for this study.
Case Studies