190
K.-Y. Jung
theta activity, immediately spreading to both frontal areas. Ictal SPECT showed
hypoperfusion in right frontal lobe, possibly indicating postictal status.
Subsequent invasive study covering right frontal areas was planned (Fig. 8.1). Two
depth electrodes targeting right medial frontal area, (channel 1–4, 5–8) two grids on
right medial frontal cortex, (channel 9–12, 21–26) and four grids covering most area
of right frontal cortex (channel 13–16, 27–36, 37–46, 47–50) were applied.
Invasive EEG revealed interictal spikes and HFOs in posterior upper frontal lobe
(channel 28, 29, 32, 33, 36, 40, 45, 46; Fig. 8.2). Especially, ictal EEG started as a
form of HFO in channel 33 (precentral gyrus in upper frontal lobe) and spread to
neighboring channels (Fig. 8.3). The corticectomy including channel 33 and irritative
zones with medial frontal cortex was performed. During 20 months after the surgery,
the patient remained seizure free maintaining only the carbamazepine 800 mg daily
in out-patient clinic. Cortical functioning was also significantly improved when the
general intelligence was evaluated using Full Scale Intelligence Quotient with the
resultant score increasing from preoperative 88 to postoperative 110.
References
1. L. Andrade-Valença, F. Mari, J. Jacobs et al., Interictal high frequency oscillations (HFOs)
in patients with focal epilepsy and normal MRI. Clin. Neurophysiol. 123, 100–105 (2012).
https://doi.org/10.1016/j.clinph.2011.06.004
2. L.P. Andrade-Valenca, F. Dubeau, F. Mari et al., Interictal scalp fast oscillations as a marker of
the seizure onset zone. Neurology 77, 524–531 (2011). https://doi.org/10.1212/WNL.0b013e
318228bee2
3. R.E.D. Bautista, M.A. Cobbs, D.D. Spencer, S.S. Spencer, Prediction of surgical outcome
by interictal epileptiform abnormalities during intracranial EEG monitoring in patients with
extrahippocampal seizures. Epilepsia 40, 880–890 (1999). https://doi.org/10.1111/j.1528-115
7.1999.tb00794.x
4. S. Beniczky, G. Lantz, I. Rosenzweig et al., Source localization of rhythmic ictal EEG activity:
a study of diagnostic accuracy following STARD criteria. Epilepsia 54, 1743–1752 (2013).
https://doi.org/10.1111/epi.12339
5. P. Boon, M. D’Havé, B. Vanrumste et al., Ictal source localization in presurgical patients with
refractory epilepsy. J. Clin. Neurophysiol. Off. Publ. Am. Electroencephalogr. Soc. 19, 461–468
(2002)
6. A. Bragin, J. Engel, C.L. Wilson et al., High-frequency oscillations in human brain. Hippocampus 9, 137–142 (1999a). https://doi.org/10.1002/(sici)1098-1063(1999)9:2<137::aid-hipo5>3.
0.co;2-0
7. A. Bragin, J. Engel, C.L. Wilson et al., Hippocampal and entorhinal cortex high-frequency
oscillations (100–500 Hz) in human epileptic brain and in kainic acid-treated rats with chronic
seizures. Epilepsia 40, 127–137 (1999b). https://doi.org/10.1111/j.1528-1157.1999.tb02065.x
8. V. Brodbeck, L. Spinelli, A.M. Lascano et al., Electroencephalographic source imaging: a
prospective study of 152 operated epileptic patients. Brain 134, 2887–2897 (2011). https://do
i.org/10.1093/brain/awr243
9. G. Buzsaki, Z. Horvath, R. Urioste et al., High-frequency network oscillation in the hippocampus. Science 256, 1025–1027 (1992)
10. J.R. Cho, D.L. Koo, E.Y. Joo et al., Resection of individually identified high-rate high-frequency
oscillations region is associated with favorable outcome in neocortical epilepsy. Epilepsia 55,
1872–1883 (2014). https://doi.org/10.1111/epi.12808
K.-Y. Jung
theta activity, immediately spreading to both frontal areas. Ictal SPECT showed
hypoperfusion in right frontal lobe, possibly indicating postictal status.
Subsequent invasive study covering right frontal areas was planned (Fig. 8.1). Two
depth electrodes targeting right medial frontal area, (channel 1–4, 5–8) two grids on
right medial frontal cortex, (channel 9–12, 21–26) and four grids covering most area
of right frontal cortex (channel 13–16, 27–36, 37–46, 47–50) were applied.
Invasive EEG revealed interictal spikes and HFOs in posterior upper frontal lobe
(channel 28, 29, 32, 33, 36, 40, 45, 46; Fig. 8.2). Especially, ictal EEG started as a
form of HFO in channel 33 (precentral gyrus in upper frontal lobe) and spread to
neighboring channels (Fig. 8.3). The corticectomy including channel 33 and irritative
zones with medial frontal cortex was performed. During 20 months after the surgery,
the patient remained seizure free maintaining only the carbamazepine 800 mg daily
in out-patient clinic. Cortical functioning was also significantly improved when the
general intelligence was evaluated using Full Scale Intelligence Quotient with the
resultant score increasing from preoperative 88 to postoperative 110.
References
1. L. Andrade-Valença, F. Mari, J. Jacobs et al., Interictal high frequency oscillations (HFOs)
in patients with focal epilepsy and normal MRI. Clin. Neurophysiol. 123, 100–105 (2012).
https://doi.org/10.1016/j.clinph.2011.06.004
2. L.P. Andrade-Valenca, F. Dubeau, F. Mari et al., Interictal scalp fast oscillations as a marker of
the seizure onset zone. Neurology 77, 524–531 (2011). https://doi.org/10.1212/WNL.0b013e
318228bee2
3. R.E.D. Bautista, M.A. Cobbs, D.D. Spencer, S.S. Spencer, Prediction of surgical outcome
by interictal epileptiform abnormalities during intracranial EEG monitoring in patients with
extrahippocampal seizures. Epilepsia 40, 880–890 (1999). https://doi.org/10.1111/j.1528-115
7.1999.tb00794.x
4. S. Beniczky, G. Lantz, I. Rosenzweig et al., Source localization of rhythmic ictal EEG activity:
a study of diagnostic accuracy following STARD criteria. Epilepsia 54, 1743–1752 (2013).
https://doi.org/10.1111/epi.12339
5. P. Boon, M. D’Havé, B. Vanrumste et al., Ictal source localization in presurgical patients with
refractory epilepsy. J. Clin. Neurophysiol. Off. Publ. Am. Electroencephalogr. Soc. 19, 461–468
(2002)
6. A. Bragin, J. Engel, C.L. Wilson et al., High-frequency oscillations in human brain. Hippocampus 9, 137–142 (1999a). https://doi.org/10.1002/(sici)1098-1063(1999)9:2<137::aid-hipo5>3.
0.co;2-0
7. A. Bragin, J. Engel, C.L. Wilson et al., Hippocampal and entorhinal cortex high-frequency
oscillations (100–500 Hz) in human epileptic brain and in kainic acid-treated rats with chronic
seizures. Epilepsia 40, 127–137 (1999b). https://doi.org/10.1111/j.1528-1157.1999.tb02065.x
8. V. Brodbeck, L. Spinelli, A.M. Lascano et al., Electroencephalographic source imaging: a
prospective study of 152 operated epileptic patients. Brain 134, 2887–2897 (2011). https://do
i.org/10.1093/brain/awr243
9. G. Buzsaki, Z. Horvath, R. Urioste et al., High-frequency network oscillation in the hippocampus. Science 256, 1025–1027 (1992)
10. J.R. Cho, D.L. Koo, E.Y. Joo et al., Resection of individually identified high-rate high-frequency
oscillations region is associated with favorable outcome in neocortical epilepsy. Epilepsia 55,
1872–1883 (2014). https://doi.org/10.1111/epi.12808