Case Report: Laser Ablation Guided by State of the Art Source Imaging Ends an Adolescent's 16-Year Quest for Seizure Freedom

Frontiers in Human Neuroscience

Human Neuroscience

Madhan Bosemani¹  Saleem Malik²  Shannon E. Conrad²  M. Scott Perry²  Sabrina Shandley²  Daniel Hansen²  Cynthia Keator²  Yanlong Song³  Christos Papadelis⁴ 

[1] Department of Radiology, Cook Children's Medical Center, Fort Worth, TX, United States;Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States;Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States;Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States;Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States;Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States;School of Medicine, Texas Christian University, University of North Texas Health Science Center, Fort Worth, TX, United States;

关键词: epilepsy surgery;    laser interstitial thermal therapy;    source imaging;    high-density EEG;    magnetoencephalography;   

DOI  :  10.3389/fnhum.2022.826139

 received in 2021-11-30, accepted in 2022-01-03,  发布年份 2022

来源: Frontiers

【 摘 要 】

Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy (DRE). Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy (LITT), improved the safety and non-invasiveness of this method. Electric and magnetic source imaging (ESI/MSI) plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for 16 years and underwent surgery at Cook Children's Medical Center (CCMC). The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography (EEG), magnetoencephalography (MEG) with simultaneous conventional EEG (19 channels) and high-density EEG (256 channels) in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography (FDG-PET). Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free (Engel 1; 12 months after surgery). Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE.

【 授权许可】

Unknown   
Copyright © 2022 Papadelis, Conrad, Song, Shandley, Hansen, Bosemani, Malik, Keator and Perry.