Abstracts

RATIONALE: To describe how recent advances in MR imaging can enhance traditional epilepsy surgery evaluations. METHODS: Case series. RESULTS: 1: A 40 year old deaf and mute man with intractable clonic motor seizures was diagnosed with low grade glioma adjacent to the left motor strip. This lesion was disguised in all MR sequences but was revealed on FLAIR imaging. Functional MR imaging (fMRI) verbal fluency paradigms consisting of Sign and English languages were devised to evaluate Broca's Area. An fMRI motor task was performed to map the motor cortex and its proximity to the lesion. The glioma was then resected; leaving him seizure-free and without deficits so far for 4 months. 2: A 31 year old man had intractable hypermotor seizures beginning with left hand numbness. Routine MRI was negative for lesions. Single voxel proton spectroscopy showed reduced NAA/Cr ratio (2.4) of the right precentral motor cortex as opposed to the same area on the left (2.74). fMRI showed activation in motor regions for both lower extremities on a motor paradigm but poor activation to lower extremity sensory paradigms of the right somatosensory cortex. Hand sensory activations were present bilaterally with an increase in ipsilateral activation on the left suggesting a right sensory cortex abnormality leading to contralateral (left) hemisphere recruitment. A presurgical evaluation is in progress. 3. A 42 year old right handed woman with intractable partial complex seizures was diagnosed with extensive heterotopia of the left temporal-parietal-occipital region with an anterotemporal porencephaly. IAP suggested left hemispheric language dominance. fMRI showed a left inferior frontal activation for Broca's area, but no activation of left superior temporal gyrus. Instead, receptive language localized to the right superior temporal gyrus. The patient underwent left temporal lobectomy and resection of the porencephalic region. As of 6 months follow-up, she is seizure-free and without language deficits. CONCLUSIONS: Traditional epilepsy surgery evaluations can now be greatly enhanced with the utilization of advanced neuroimaging techniques.