Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery

Jing Zhang,1 Qingzhu Liu,2 Shanshan Mei,2 Xiaoming Zhang,2 Xiaofei Wang,2 Weifang Liu,1 Hui Chen,1 Hong Xia,1 Zhen Zhou,1 Yunlin Li2 1School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China; 2Department of Functional Neurology and Neurosurgery, Beiji...

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Autores principales:	Zhang J, Liu Q, Mei S, Zhang X, Wang X, Liu W, Chen H, Xia H, Zhou Z, Li Y
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/ab5cf92493fc48408eb8e9a968a0ba0a
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spelling	oai:doaj.org-article:ab5cf92493fc48408eb8e9a968a0ba0a2021-12-02T06:33:32ZPresurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery1176-63281178-2021https://doaj.org/article/ab5cf92493fc48408eb8e9a968a0ba0a2013-07-01T00:00:00Zhttp://www.dovepress.com/presurgical-eeg-fmri-in-a-complex-clinical-case-with-seizure-recurrenc-a13804https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Jing Zhang,1 Qingzhu Liu,2 Shanshan Mei,2 Xiaoming Zhang,2 Xiaofei Wang,2 Weifang Liu,1 Hui Chen,1 Hong Xia,1 Zhen Zhou,1 Yunlin Li2 1School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China; 2Department of Functional Neurology and Neurosurgery, Beijing Haidian Hospital, Beijing, People's Republic of China Abstract: Epilepsy surgery has improved over the last decade, but non-seizure-free outcome remains at 10%–40% in temporal lobe epilepsy (TLE) and 40%–60% in extratemporal lobe epilepsy (ETLE). This paper reports a complex multifocal case. With a normal magnetic resonance imaging (MRI) result and nonlocalizing electroencephalography (EEG) findings (bilateral TLE and ETLE, with more interictal epileptiform discharges [IEDs] in the right frontal and temporal regions), a presurgical EEG-functional MRI (fMRI) was performed before the intraoperative intracranial EEG (icEEG) monitoring (icEEG with right hemispheric coverage). Our previous EEG-fMRI analysis results (IEDs in the left hemisphere alone) were contradictory to the EEG and icEEG findings (IEDs in the right frontal and temporal regions). Thus, the EEG-fMRI data were reanalyzed with newly identified IED onsets and different fMRI model options. The reanalyzed EEG-fMRI findings were largely concordant with those of EEG and icEEG, and the failure of our previous EEG-fMRI analysis may lie in the inaccurate identification of IEDs and wrong usage of model options. The right frontal and temporal regions were resected in surgery, and dual pathology (hippocampus sclerosis and focal cortical dysplasia in the extrahippocampal region) was found. The patient became seizure-free for 3 months, but his seizures restarted after antiepileptic drugs (AEDs) were stopped. The seizures were not well controlled after resuming AEDs. Postsurgical EEGs indicated that ictal spikes in the right frontal and temporal regions reduced, while those in the left hemisphere became prominent. This case suggested that (1) EEG-fMRI is valuable in presurgical evaluation, but requires caution; and (2) the intact seizure focus in the remaining brain may cause the non-seizure-free outcome. Keywords: EEG-fMRI, focus localization, presurgical evaluation, epilepsy surgeryZhang JLiu QMei SZhang XWang XLiu WChen HXia HZhou ZLi YDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2013, Iss default, Pp 1003-1010 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Zhang J Liu Q Mei S Zhang X Wang X Liu W Chen H Xia H Zhou Z Li Y Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery
description	Jing Zhang,1 Qingzhu Liu,2 Shanshan Mei,2 Xiaoming Zhang,2 Xiaofei Wang,2 Weifang Liu,1 Hui Chen,1 Hong Xia,1 Zhen Zhou,1 Yunlin Li2 1School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China; 2Department of Functional Neurology and Neurosurgery, Beijing Haidian Hospital, Beijing, People's Republic of China Abstract: Epilepsy surgery has improved over the last decade, but non-seizure-free outcome remains at 10%–40% in temporal lobe epilepsy (TLE) and 40%–60% in extratemporal lobe epilepsy (ETLE). This paper reports a complex multifocal case. With a normal magnetic resonance imaging (MRI) result and nonlocalizing electroencephalography (EEG) findings (bilateral TLE and ETLE, with more interictal epileptiform discharges [IEDs] in the right frontal and temporal regions), a presurgical EEG-functional MRI (fMRI) was performed before the intraoperative intracranial EEG (icEEG) monitoring (icEEG with right hemispheric coverage). Our previous EEG-fMRI analysis results (IEDs in the left hemisphere alone) were contradictory to the EEG and icEEG findings (IEDs in the right frontal and temporal regions). Thus, the EEG-fMRI data were reanalyzed with newly identified IED onsets and different fMRI model options. The reanalyzed EEG-fMRI findings were largely concordant with those of EEG and icEEG, and the failure of our previous EEG-fMRI analysis may lie in the inaccurate identification of IEDs and wrong usage of model options. The right frontal and temporal regions were resected in surgery, and dual pathology (hippocampus sclerosis and focal cortical dysplasia in the extrahippocampal region) was found. The patient became seizure-free for 3 months, but his seizures restarted after antiepileptic drugs (AEDs) were stopped. The seizures were not well controlled after resuming AEDs. Postsurgical EEGs indicated that ictal spikes in the right frontal and temporal regions reduced, while those in the left hemisphere became prominent. This case suggested that (1) EEG-fMRI is valuable in presurgical evaluation, but requires caution; and (2) the intact seizure focus in the remaining brain may cause the non-seizure-free outcome. Keywords: EEG-fMRI, focus localization, presurgical evaluation, epilepsy surgery
format	article
author	Zhang J Liu Q Mei S Zhang X Wang X Liu W Chen H Xia H Zhou Z Li Y
author_facet	Zhang J Liu Q Mei S Zhang X Wang X Liu W Chen H Xia H Zhou Z Li Y
author_sort	Zhang J
title	Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery
title_short	Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery
title_full	Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery
title_fullStr	Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery
title_full_unstemmed	Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery
title_sort	presurgical eeg-fmri in a complex clinical case with seizure recurrence after epilepsy surgery
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/ab5cf92493fc48408eb8e9a968a0ba0a
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Presurgical EEG-fMRI in a complex clinical case with seizure recurrence after epilepsy surgery

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