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Arthur Cukiert, Cassio Forster, Viviane Ferreira, Leila Frayman, Jose Buratini.
Epilepsy Surgery Program- Hospital Brigadeiro and Sao Paulo Epilepsy Clinic, Sao Paulo SP, Brazil
RATIONALE- Nodular periventricular heterotopia is rare and usually bilateral. Due to its diffuse characteristics, strictly focal epileptogenesis is rare and results from surgery in these patients are worse then in other epileptic syndromes. This paper describes a case of unilateral periventricular nodular heterotopia treated surgically, in whom a clearcut temporal epileptogenicity was shown.
MATERIAL- A.M., a 32 years-old woman, started with seizures at the age of 8 years. Seizures were simple partial autonomic and complex with right arm automatisms and left arm paresis in a frequency of 1 per day. Interictal and ictal EEG recordings were consistent with a right temporal focus. MRI disclosed periventricular nodules that could be seen throughout all the ependima of the right lateral ventricle, including the temporal, frontal and occipital horns and atrium (Figures 1 and 2).
RESULTS- She was submitted to a cortico-amigdalo-hippocampectomy under ECoG guidance and general anesthesia (Figure 3). Surgery included extensive resection of the hippocampus, parahippocampal and fusiform gyrus (Figures 4 and 5), leaving the more posterior periventricular nodules in the occipital area in place. She is having 1 seizure/month since surgery (10 months).
DISCUSSION- Diffuse developmental syndromes may show focal epileptogenic features. Surgical results are probably better in unilateral rather then in bilateral periventricular nodular heterotopias.