A case of epilepsy surgery failure

Présentation au sujet: "A case of epilepsy surgery failure"— Transcription de la présentation:

1 A case of epilepsy surgery failure
Alain Bouthillier MD,MSc,FRCSC Clinical Professor and Chairman Division of Neurosurgery Université de Montréal

2 Disclosures Research support: Speaker honoraria: UCB Canada Inc
CHUM Fondation (fellow) Ad-Tech Medical Instrument Corp. Speaker honoraria: UCB Canada Inc

3 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.

4 Disclosures PhD student 2:
Natural Sciences and Engineering Research Council of Canada, Savoy Foundation, Quebec Bio-Imaging Network, Savoy Fundation

5 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

6 Focal PNH

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11 PET: diffuse LT hypo

12 SISCOM

13 MEG

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23 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

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25 After surgery Seizures restart 1 week after surgery (same)
Normal visual fields Patho: Focal CD 1A

26 Focal periventricular nodular heterotopia (PNH)

27 Next step ? Open surgery ? Radio-frequency ? Radiosurgery ?
Ultrasound ? Lazer ? Medication change ?