Affiliations: Department of Pediatric Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia | Neuronavigation and Intraoperative MRI Unit, Department of Neurophysiology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia | Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia | King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
Note:  Corresponding author: Dr. Adel A.H. Mahmoud, Pediatric Neurology Department, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia. Tel.: +966543376723; Fax: +966112889999/11291; E-mail: [email protected]
Abstract: Despite the expanding number of new generations of antiepileptic drugs, there continues to be a significant proportion of patients with epilepsy who are refractory to medical treatment. Other treatment options include the ketogenic diet, vagal nerve stimulation and other modalities including epilepsy surgery. The ideal patient for surgery could be the one with focal resectable lesion in an approachable area. This would be uncontroversial when the lesion is ipsilateral to the epilpetogenic discharges as per imaging and encephalogram studies. There has been growing evidence that with generalized or multifocal epileptiform discharges or even with those lesions on one side and ictal/interictal epileptiform discharges on the opposite side, removal of the pathological lesion would help seizure control. Here we describe a patient with epileptiform discharges (ictal and interictal) contralateral to her actual encephalomalacic lesion, when antiepileptic drugs in good doses and for enough duration failed to control the seizures.
Keywords: Epilepsy, lesion, focus, contralateral, epilepsy surgery