Abstracts

Rationale: Epilepsy Surgery is often entertained after failure of 2 to 3 AED s. Factors negating surgery include potential for impairing primary and multiple or bilateral sites of seizure onset in the same individual. Palliative procedures, special diets and the addition of further medications are therefore the only options available to some individuals with Epilepsy. Functional Mapping and direct cortical stimulation have helped to guide surgical procedures but this does not address the necessity in some individuals to traverse and resects normal cortex to remove the epileptogenic region. MRI guided thermal ablation offers a new and relatively safe way of targeting the epileptiform focus yet minimizing risk of functional impairment. Most case target isolated lesions however we discuss two cases of bilateral and multiple successful ablations.Methods: Two patients with pharmacoresistant epilepsy, both of whom were declined as candidates for traditional Epilepsy Surgery, underwent a phase 2 with bilateral depths placed through burr holes. In the first case depths traversed dysplasia in the occipital regions and abutting the ventricles. Case two had a depth traversing the insular and sampling bilateral peri-ventricular nodules. Results: Pre operative testing including SPECT suggested involvement of the right tempero-occipital region in the first case; however originated from both regions of cortical dysplasia with invasive monitoring and they were both ablated with retention of vision. Bilateral independent seizures were also identified in the second case with the insular cortex and a peri-ventricular nodule on the right and a nodule on the left ablated. 3 acute atypical seizures occurred in one individual however both have been seizure free since. Both cases went home the day following surgery.Conclusions: Monitoring of bilateral foci revealed deferent sites of seizure onset though semiology of clinical events was similar and, in case one, pre-surgical evaluation revealed focal involvement. Both candidates would not have been traditional surgical candidates and neither had postoperative sequelea.