Intracranial investigation of a patient with nodular heterotopia and hippocampal sclerosis: dealing with a dual pathology

The pre‐operative assessment and surgical management of patients with dual pathology is challenging. We describe a patient with drug‐resistant focal epilepsy with hippocampal sclerosis and extensive periventricular nodular heterotopia in the same hemisphere. The semiology, scalp EEG, and imaging wer...

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Bibliographic Details
Published in:Epileptic disorders 2017-06, Vol.19 (2), p.195-201
Main Authors: Ladino, Lady Diana, Dash, Chelsea, Wu, Adam, Tellez‐Zenteno, Jose Francisco
Format: Article
Language:English
Subjects:
Adult
Cerebral Ventricles - pathology
Cortex
Drug resistance
Drug Resistant Epilepsy - pathology
Drug Resistant Epilepsy - physiopathology
Drug Resistant Epilepsy - surgery
dual pathology
EEG
Epilepsies, Partial - pathology
Epilepsies, Partial - physiopathology
Epilepsies, Partial - surgery
Epilepsy
epilepsy surgery
Female
Hippocampus
Hippocampus - pathology
Humans
Localization
Nervous System Malformations - pathology
Neurodevelopmental disorders
periventricular nodular heterotopia
posterior‐quadrant epilepsy
Sclerosis
Sclerosis - pathology
Seizures
temporal lobectomy
Ventricle (lateral)
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Summary:The pre‐operative assessment and surgical management of patients with dual pathology is challenging. We describe a patient with drug‐resistant focal epilepsy with hippocampal sclerosis and extensive periventricular nodular heterotopia in the same hemisphere. The semiology, scalp EEG, and imaging were divergent, but the presence of focal interictal and ictal epileptic discharges of the putative ictal onset zone resulted in successful localization of the epileptogenic zone. A less aggressive resection was performed based on intracranial EEG recording. The patient has been seizure‐free for three years since resection. Electroclinical hypotheses and challenges in defining the epileptogenic network are discussed.
ISSN:1294-9361
1950-6945
DOI:10.1684/epd.2017.0912