SEEG-RF for revealing and treating Geschwind syndrome's epileptic network: A case study

• Published in: Epilepsy & behavior reports 2023-01, Vol.24, p.100617, Article 100617
• Main Authors: Levy, Mikael, Weinstein, Maya, Mirson, Alexie, Madar, Sandi, Lorberboym, Mordechai, Getter, Nir, Zer-Zion, Moshe, Sepkuty, Jehuda
• Format: Article
• Language: English
• Subjects: Case Report; Drug-refractory epilepsy; Epileptic network; Geschwind syndrome; Stereo electroencephalogram-guided radiofrequency; Video electroencephalogram
• ISSN: 2589-9864; 2589-9864
• DOI: 10.1016/j.ebr.2023.100617

• SEEG exploration of epilepsy in Geschwind syndrome identified the epileptic network. • SEEG-guided RF ablation resolved seizures and considerably improved psycho-affective issues. • Findings suggest behavioral problems may arise from persistent interictal activity. Stereotypic neural networks are repeatedly activated in drug-refractory epilepsies (DRE), reinforcing the expression of certain psycho-affective traits. Geschwind syndrome (GS) can serve as a model for such phenomena among patients with temporal lobe DRE. We describe stereo-electroencephalogram (SEEG) exploration in a 34-year-old male with DRE and GS, and his treatment by SEEG-radiofrequency (SEEG-RF) ablation. We hypothesized that this approach could reveal the underlying epileptic network and map eloquent faculties adjacent to SEEG-RF targets, which can be further used to disintegrate the epileptic network. The patient underwent a multi-modal pre-surgical evaluation consisting of video EEG (VEEG), EEG source localization, 18-fluorodexyglucose-PET/MRI, neuropsychological and psychiatric assessments. Pre-surgical multi-modal analyses suggested a T4-centered seizure onset zone. SEEG further localized the SOZ within the right amygdalo-hippocampal region and temporal neocortex, with the right parieto-temporal region as the propagation zone. SEEG-RF ablation under awake conditions and continuous EEG monitoring confirmed the abolishment of epileptic activity. Follow-up at 20 months showed seizure suppression (Engel 1A/ILEA 1) and a significantly improved and stable psycho-affective state. To the best of our knowledge this is the first description of the intracranial biomarkers of GS and its further treatment through SEEG-RF ablation within the scope of DRE.