Drug-resistant, nonlesional, extratemporal lobe focal epilepsy can be difficult to treat and may require a high degree of multidisciplinary teamwork to localize the seizure onset zone for resective surgery. Here, we describe a patient with longstanding drug-resistant, nonlesional, extratemporal focal epilepsy with a high seizure burden who became seizure-free after prolonged evaluation and eventual left frontal cortical resection. Prior evaluations included magnetoencephalography, invasive video-EEG monitoring, and implantation of a responsive neurostimulation (RNS) device for ongoing intracranial stimulation. Highly sophisticated techniques were utilized including stereotactic localization of prior evaluations to guide repeat stereo-EEG (SEEG), electrical stimulation mapping, SEEG-guided radiofrequency ablation, and awake resection with language and motor mapping using a cognitive testing platform . Incorporating a wide array of data from multiple centers and evaluation time periods was necessary to optimize seizure control and minimize the risk of neurological deficits from surgery.
Keywords: ASMs, anti-seizure medications; Awake cortical resection; EMU, epilepsy monitoring unit; ESM, electrical stimulation mapping; Electrical stimulation mapping; Epilepsy surgery; RNS, responsive neurostimulation; SEEG; SEEG, stereo-EEG; SEEG-guided radiofrequency ablation; SMA, supplementary motor area; SOZ, seizure onset zone.
© 2022 The Authors.