[DIAGNOSIS AND TREATMENT OF A GIRL SUFFERING FROM DRUG RESISTANT EPILEPSY WITH AN INNOVATIVE MINIMALLY INVASIVE APPROACH].

ABSTRACT

INTRODUCTION: About one percent (over 81,000 patients) of the Israeli population suffer from epilepsy. The main treatment for this condition is medication, but about a third of the patients suffer from drug-resistant epilepsy (DRE). Each year about 5,000 new patients are diagnosed with epilepsy, of whom 3,000 are children. For these patients, an evaluation in designated centers is required in order to diagnose possible foci and propose neurosurgical treatment alternatives. BACKGROUND: A model for diagnosis and treatment of the epileptic network in a minimally invasive approach is presented through the description of a case study. Phase I includes diagnosis of the semiology, neuropsychological assessment, video EEG recording and performing a PET-MRI-FMRI-EEG synchronized examination. Phase II involves stereo-electroencephalography (SEEG) minimally invasive diagnosis to target the epileptic area and accurately map adjacent functional areas and assessment of cortical redundancy. Phase III includes radiofrequency ablation of the foci without any further surgery. This procedure is performed under clinical monitoring (the patient is awake during treatment) and continuous EEG monitoring. CONCLUSIONS: This case study demonstrates the multi-dimensional model performed by a multidisciplinary team, combining innovative technologies. This model is essential for the precision of the diagnosis and treatment methods of focal epilepsy and allows preservation of function based, among other factors, on the identification of cortical redundancy. DISCUSSION: The preoperative assessment identified focal epilepsy adjacent to the motor area dominating the right hand. A combined PET-FMRI-MRI-EEG examination enabled detecting redundancy of motor functions beyond the epileptic focus. Based on this information, a targeted implantation of depth electrodes (SEEG) was performed, the epileptic foci were identified and targeted ablations were performed during clinical monitoring and continuous EEG. This resulted in the cessation of seizures in parallel with the disappearance of the pathological signal in the EEG, all while preserving the patient's hand function.