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Epileptic Disorders

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Intracranial investigation of a patient with nodular heterotopia and hippocampal sclerosis: dealing with a dual pathology Volume 19, issue 2, June 2017

Figure 1

Right temporal intermittent rhythmic delta activity (TIRDA), maximal at F8-T4 (bipolar longitudinal montage: HFF: 70 Hz; LFF: 1 Hz; sensitivity: 7 μV/mm; time base: 30 mm/sec).

Figure 2

Right anterior temporal sharp waves, maximal at F8-T4 (bipolar longitudinal montage with sphenoidal electrodes: HFF: 70 Hz; LFF: 1 Hz; sensitivity: 7 μV/mm; time base: 30 mm/sec).

Figure 3

Scalp EEG during seizure. Recording showing build-up of lateralized ictal rhythmic 4-5-Hz activity, maximal at F8-T4, with rapid involvement of the ipsilateral scalp sphenoidal electrode (bipolar longitudinal montage with sphenoidal electrodes: HFF: 70 Hz; LFF: 1 Hz; sensitivity: 7 μV/mm; time base: 30 mm/sec).

Figure 4

1.5 Tesla MRI illustrating unilateral nodular heterotopia malformation at the right temporal region which extended to the occipital area. (A) T2-weighted coronal image showing multiple nodules in the anterior temporal area and abnormal insular gyration. (B) T2-weighted axial image showing periventricular heterotopic nodules in the right posterior temporo-occipital region; the nodules had the same signal intensity as the overlying grey matter. (C) T2-weighted axial image illustrating abnormal occipital cortex gyration. (D) T2-weighted coronal image showing extensive posterior heterotopic grey matter.

Figure 5

T1-weighted MRI postoperative images illustrating the position of the intracranial depth electrodes. Each electrode had eight contacts, numbered 1 to 8 from mesial to lateral. (A) T1-weighted coronal image showing the most anterior electrode, denominated HH (hippocampal head). (B) T1-weighted axial image showing HB (hippocampal body) and PT (posterior temporal) electrodes. (C) T1-weighted coronal image showing the PT electrode covering the majority of heterotopic nodules.

Figure 6

Intracranial EEG recording with depth electrodes showed a clear onset over the mesial electrodes in the right temporal region. The onset of the seizure is marked by a burst of high-amplitude sharp-wave complexes, rapidly followed by a discharge of focal fast activity in the mesial temporal areas (HH1, HH2, HH3, HB1, and HB2). Heterotopic nodules (PT electrode) were silent during the seizures.

Figure 7

Post-surgical CT scan.