Stereo-EEG tailored resection in a child with presumed perinatal post-stroke epilepsy: The complex organization of epileptogenic zone.

Introduction: Only a few studies have focused on tailored resection in post-stroke epilepsy, in which hemispherectomy and hemispherotomy are the most recognized treatments. Case description: We describe the case of a patient with drug-resistant, presumed perinatal, post-stroke epilepsy and moderate right hemiparesis. The seizures were stereotyped, both spontaneous and induced by sudden noises and somatosensory stimuli. Considering the discordant anatomic-electro-clinical data - left perisylvian malacic lesion with electrical onset over the left mesial fronto-central leads - and the patient's functional preservation, SEEG was performed. SEEG revealed sub-continuous abnormalities in the perilesional regions. Several seizures were recorded, with onset over the premotor area, rapidly involving the motor and insular-opercular regions. We decided for a combined surgical approach, SEEG-guided radiofrequency thermocoagulation, on the fronto-mesial structure but also on the central operculum, followed by resective surgery including only the fronto-mesial structures. Discussion and conclusion: The SEEG allowed to localize the epileptogenic zone far away from the anatomical lesion but connected to part of it. A combined surgical approach tailored on SEEG results allowed a good outcome (Engel Ib) without additional deficits.

Increased expression of the growth-associated protein-43 gene after primary motor cortex lesion in macaque monkeys.

We recently showed that changes of brain activity in the ipsilesional ventral premotor cortex (PMv) and perilesional primary motor cortex (M1) of macaque monkeys were responsible for recovery of manual dexterity after lesioning M1. To investigate whether axonal remodeling is associated with M1 lesion-induced changes in brain activity, we assessed gene expression of growth-associated protein-43 (GAP-43) in motor and premotor cortices. Increased expression was observed in the PMv during the period just after recovery and in the perilesional M1 during the plateau phase of recovery. Time-dependent and brain region-specific remodeling may play a role in functional recovery after lesioning M1.