Succesful epilepsy surgery in intractable epilepsy: A case report

Introduction: In spite of appropriate management,seizures are not controlled in۱۰ to ۲۰ percent of epileptic children.In patients with intractable epilepsy if we can find theseizure focus, and resect it by epilepsy surgery, patient may be cured from refractory seizures. Long Term Video-EEG Monitoring (LTM), MRI with Voxel-BasedMorphometry (VBM) and ictal SPECT may give us very important information in the preoperative assessment of these patients. Clinical History: The patient is a ۶-year-old right handed girl, she was referred to LTM unit with diagnosis of intractable epilepsy since ۳ years of age. Her attacks were started by psychic aura (feels fear as well as chest and throat burning) which followed by left facial tonic spasm then left facial and arm clonic jerks with clonic blinking of both eyelids. These attacks were recurred as cluster of seizures every day. In some of the attacks she was falling and became unconscious. Past History: She was a product of elective cesarian section of a full term birth with nocomplication during pregnancy and the only child of a consanguinous marriage without a history of febrile seizures and no family history of epilepsy. Physical and neurologicexam was normal ,mental and physical development was normal. Current medications: Oxcarbazepin ۳۰۰ mg BID, Keppra ۱۰۰۰ mg BID and Clobazam ۱۰ mg BIDPrevious medications: ACTH, Sabril, Lamotrigine, Topiramate,Nitrazepam,Depakine, Acetazolamid,Tegretol and Phenytoin. Dedicated Brain MRI: Normal. Brain MRI With VBM: Right frontotemporal abnormal cortex. LTM: Epileptogenic zone is located in Right frontal lobe epilepsy. Spect: Increased uptake in right frontal area near right temporal area in ictal phase compared with interictal phase. Epilepsy surgery meeting: She is canditate for invasive intracranial EEG recording. invasive EEG monitoring: She underwent craniotomy and subdural grid implantation (۳۲ disk electrodes) over the right frontotemporal area for intracranial EEG recording and transferred from operating room to EMU. During ۳ days EMU stay ۳۸ events were recorded. Final diagnosis: Right frontal lobe epilptogenic zone near face motor area. Comment: Excision of Epileptogenic zone beneat electrodes ۲۸, ۲۷ and ۱۹. Pathology: cortical dysplasia Epilepsy surgery: Cortical excision was performed beneat ۲۸, ۲۷ and ۱۹ electrdes Follow up: She has been seizure free after the surgery for ۹ months .She is continuing the previous medications. We can taper one of the medications if she will be seizure free for one year .

کلیدواژه ها:

Intractable Epilepsy ، LTM ، VBM ، Epilepsy Surgery.