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Title: How small can the epileptogenic region be? A case in point.
Austin Authors: Jackson, Graeme D ;Pedersen, Mangor;Harvey, A Simon
Affiliation: The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
Department of Neurology, Royal Children's Hospital, Melbourne, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 23-May-2017 2017-04-26
Publication information: Neurology 2017; 88(21): 2017-2019
Abstract: To present a case that demonstrates that seizures and interictal disturbances can be driven by a small area of functionally abnormal cortex. Two novel functional MRI network analysis methods were used to supplement conventional seizure and lesion localization methods: (1) regional homogeneity to quantify local connectivity, or synchrony, with a resolution of less than 1 cm3 of cortex; and (2) small-worldness to combine information about whole brain network segregation and integration. After a small corticectomy in the dominant supramarginal gyrus (13 × 7 × 6 mm) limited to the area of abnormal local connectivity, and smaller than the PET and SPECT abnormalities, the patient has been seizure-free for 3 years with no language deficit. Whole brain network characteristics normalized (small-worldness) to that of healthy controls. This case demonstrates that small areas of cortex may be highly epileptogenic, drive intractable epilepsy, and disrupt large-scale networks likely to be involved in core cognitive functions.
DOI: 10.1212/WNL.0000000000003962
PubMed URL: 28446651
Type: Journal Article
Appears in Collections:Journal articles

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