Sarah A Kelley1, Shenandoah Robinson2, Nathan E Crone1, Bruno P Soares3. 1. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower, Room 4174, Baltimore, MD, 21287, USA. bruno.soares@jhmi.edu.
Abstract
INTRODUCTION: Bottom-of-sulcus focal cortical dysplasias are an under recognized, surgically treatable cause of focal epilepsy. Resection can dramatically reduce the seizure burden for children with refractory epilepsy, or eliminate seizures altogether. MATERIAL AND METHODS: We report the case and present the results of multimodality evaluation of a 15-year-old young man who presented with long-standing partial epilepsy affecting his right leg, which over the years became refractory to therapy. RESULTS: High-resolution 3T MRI images acquired as a dedicated epilepsyprotocol were initially interpreted as unremarkable. On further review by an experienced specialist aware of clinical and electroencephalographic findings, a subtle focal cortical dysplasia was identified at the bottom of a sulcus near the medial aspect of the left precentral gyrus. After confirmation of the extent of the lesion with PET and ultra-high field 7T MRI, the patient underwent cortical mapping and focal resection and remains free of seizures. COCLUSIONS: This case emphasizes the need for a multidisciplinary approach to the evaluation of refractory focal epilepsy in children and highlights the potential role of ultra-high field 7T MRI in identifying the often subtle causative anatomic abnormalities.
INTRODUCTION: Bottom-of-sulcus focal cortical dysplasias are an under recognized, surgically treatable cause of focal epilepsy. Resection can dramatically reduce the seizure burden for children with refractory epilepsy, or eliminate seizures altogether. MATERIAL AND METHODS: We report the case and present the results of multimodality evaluation of a 15-year-old young man who presented with long-standing partial epilepsy affecting his right leg, which over the years became refractory to therapy. RESULTS: High-resolution 3T MRI images acquired as a dedicated epilepsyprotocol were initially interpreted as unremarkable. On further review by an experienced specialist aware of clinical and electroencephalographic findings, a subtle focal cortical dysplasia was identified at the bottom of a sulcus near the medial aspect of the left precentral gyrus. After confirmation of the extent of the lesion with PET and ultra-high field 7T MRI, the patient underwent cortical mapping and focal resection and remains free of seizures. COCLUSIONS: This case emphasizes the need for a multidisciplinary approach to the evaluation of refractory focal epilepsy in children and highlights the potential role of ultra-high field 7T MRI in identifying the often subtle causative anatomic abnormalities.
Authors: Paul A M Hofman; Gregory J Fitt; A Simon Harvey; Ruben I Kuzniecky; Graeme Jackson Journal: AJR Am J Roentgenol Date: 2011-04 Impact factor: 3.959
Authors: A Simon Harvey; Simone A Mandelstam; Wirginia J Maixner; Richard J Leventer; Mira Semmelroch; Duncan MacGregor; Renate M Kalnins; Yuliya Perchyonok; Gregory J Fitt; Sarah Barton; Michael J Kean; Gavin C A Fabinyi; Graeme D Jackson Journal: Neurology Date: 2015-04-17 Impact factor: 9.910
Authors: Jose Eduardo Peixoto-Santos; Luciana Estefani Drumond de Carvalho; Ludmyla Kandratavicius; Paula Rejane Beserra Diniz; Renata Caldo Scandiuzzi; Roland Coras; Ingmar Blümcke; Joao Alberto Assirati; Carlos Gilberto Carlotti; Caio Cesar Marconato Simoes Matias; Carlos Ernesto Garrido Salmon; Antonio Carlos Dos Santos; Tonicarlo R Velasco; Marcio Flavio D Moraes; Joao Pereira Leite Journal: Front Neurol Date: 2018-11-20 Impact factor: 4.003
Authors: Giske Opheim; Anja van der Kolk; Karin Markenroth Bloch; Albert J Colon; Kathryn A Davis; Thomas R Henry; Jacobus F A Jansen; Stephen E Jones; Jullie W Pan; Karl Rössler; Joel M Stein; Maria C Strandberg; Siegfried Trattnig; Pierre-Francois Van de Moortele; Maria Isabel Vargas; Irene Wang; Fabrice Bartolomei; Neda Bernasconi; Andrea Bernasconi; Boris Bernhardt; Isabella Björkman-Burtscher; Mirco Cosottini; Sandhitsu R Das; Lucie Hertz-Pannier; Sara Inati; Michael T Jurkiewicz; Ali R Khan; Shuli Liang; Ruoyun Emily Ma; Srinivasan Mukundan; Heath Pardoe; Lars H Pinborg; Jonathan R Polimeni; Jean-Philippe Ranjeva; Esther Steijvers; Steven Stufflebeam; Tim J Veersema; Alexandre Vignaud; Natalie Voets; Serge Vulliemoz; Christopher J Wiggins; Rong Xue; Renzo Guerrini; Maxime Guye Journal: Neurology Date: 2020-12-22 Impact factor: 9.910