A case of epilepsy surgery failure Alain Bouthillier MD,MSc,FRCSC Clinical Professor and Chairman Division of Neurosurgery Université de Montréal
Disclosures Research support: Speaker honoraria: UCB Canada Inc CHUM Fondation (fellow) Ad-Tech Medical Instrument Corp. Speaker honoraria: UCB Canada Inc
Disclosures PhD student 1: Bourse de recrutement pour le programme de sciences neurologiques de l'Université de Montréal; Bourse de recrutement de la Faculté de médecine de l'Université de Montréal; Bourse FRQS - Bourse de formation de maîtrise pour détenteur de diplôme professionnel; Bourse de stagiaire de la Fondation Savoy.
Disclosures PhD student 2: Natural Sciences and Engineering Research Council of Canada, Savoy Foundation, Quebec Bio-Imaging Network, Savoy Fundation
35 y/o woman, left handed Epilepsy started 12 y/o Aura: Something moves in front of her Anomia Dyscognitive seizures q 1 week Neuropsy: word finding difficulties Want to drive, hemianopia unacceptable
Focal PNH
PET: diffuse LT hypo
SISCOM
MEG
Results IC study Interictal spikes: Ictal: Medial temporal and subtemporal Post temp neocortex syncronised with heterotopia Ictal: Post temporal neocortex and heterotopia simutaneous Propagation to medial temporal
After surgery Seizures restart 1 week after surgery (same) Normal visual fields Patho: Focal CD 1A
Focal periventricular nodular heterotopia (PNH)
Next step ? Open surgery ? Radio-frequency ? Radiosurgery ? Ultrasound ? Lazer ? Medication change ?