John Libbey Eurotext

SEEG re-exploration in a patient with complex frontal epilepsy with rapid perisylvian propagation and mixed “startle - reflex” seizures Volume 23, issue 1, February 2021

Videos

  • SEEG re-exploration in a patient with complex frontal epilepsy with rapid perisylvian propagation and mixed “startle - reflex’’ seizures
  • SEEG re-exploration in a patient with complex frontal epilepsy with rapid perisylvian propagation and mixed “startle - reflex’’ seizures
  • SEEG re-exploration in a patient with complex frontal epilepsy with rapid perisylvian propagation and mixed “startle - reflex’’ seizures

Figures

  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
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Tables

Authors
1 Van Gogh Epilepsy Surgery Unit, Neurology Department, CIC 1414, University Hospital, Rennes, France
2 Physics Department, University of Bucharest, Bucharest, Romania
3 Neurology Department, Grenoble University Hospital, Grenoble, France
4 Grenoble Neuroscience Institute, Grenoble Alpes University, Grenoble, France
5 Laboratory of Signal and Image Analysis, INSERM U1099, University Rennes 1, France
6 Neurology Department, University Emergency Hospital, Bucharest, Romania
7 Neurology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
8 Claudio Munari Epilepsy Surgery Centre, Neurosciences Department, GOM Niguarda Hospital, Milano, Italy
* Correspondence: Mihai Dragos Maliia Van Gogh Epilepsy Surgery Unit, Neurology Department, CIC 1414, University Hospital, Rennes, France

The SEEG International Course, organised in 2017, focused on the investigation and surgery of insulo-perisylvian epilepsies. We present one representative complex case that was discussed. The patient had seizures displaying startle/reflex components. He was MRI negative, while other non-invasive investigations offered only partially concordant data. Initial SEEG exploration resulted in an incomplete definition of the epileptogenic zone. A second SEEG followed, which led to a thorough assessment of the seizure onset zone and the epileptic network, localised to the lateral inferior premotor cortex, explaining the incongruent data obtained beforehand. This was the basis of a tailored resection with a favourable outcome. The patient has been seizure-free for five years without any motor nor cognitive deficits, but with pharmacodependence to one AED. The electroclinical reasoning is presented, accompanied by relevant commentaries and recommendations from the tutors [Published with video sequences].