SEEG-RF for revealing and treating Geschwind syndrome's epileptic network: A case study

Mikael Levy, Maya Weinstein, Alexie Mirson, Sandi Madar, Mordechai Lorberboym, Nir Getter, Moshe Zer-Zion, Jehuda Sepkuty

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Stereotypic neural networks are repeatedly activated in drug-refractory epilepsies (DRE), reinforcing the expression of certain psycho-affective traits. Geschwind syndrome (GS) can serve as a model for such phenomena among patients with temporal lobe DRE. We describe stereo-electroencephalogram (SEEG) exploration in a 34-year-old male with DRE and GS, and his treatment by SEEG-radiofrequency (SEEG-RF) ablation. We hypothesized that this approach could reveal the underlying epileptic network and map eloquent faculties adjacent to SEEG-RF targets, which can be further used to disintegrate the epileptic network. The patient underwent a multi-modal pre-surgical evaluation consisting of video EEG (VEEG), EEG source localization, 18-fluorodexyglucose-PET/MRI, neuropsychological and psychiatric assessments. Pre-surgical multi-modal analyses suggested a T4-centered seizure onset zone. SEEG further localized the SOZ within the right amygdalo-hippocampal region and temporal neocortex, with the right parieto-temporal region as the propagation zone. SEEG-RF ablation under awake conditions and continuous EEG monitoring confirmed the abolishment of epileptic activity. Follow-up at 20 months showed seizure suppression (Engel 1A/ILEA 1) and a significantly improved and stable psycho-affective state. To the best of our knowledge this is the first description of the intracranial biomarkers of GS and its further treatment through SEEG-RF ablation within the scope of DRE.

Original languageEnglish
Article number100617
JournalEpilepsy and Behavior Reports
Volume24
DOIs
StatePublished - 1 Jan 2023

Keywords

  • Drug-refractory epilepsy
  • Epileptic network
  • Geschwind syndrome
  • Stereo electroencephalogram-guided radiofrequency
  • Video electroencephalogram

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Behavioral Neuroscience

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