Surgery for intractable epilepsy in a 14-year-old girl

WW Cheng, H Otsubo, OC Snead
Department of Paediatrics, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Hong Kong

We report on a 14-year-old girl who presented with a 2-year history of simple and complex partial seizures with secondary generalisation. Monotherapy using carbamazepine and combination therapy using carbamazepine and gabapentin had been tried within the 2 years before presentation. Seizure control, however, was poor. Magnetic resonance imaging showed structural abnormalities over the right occipital and temporal lobes. Continuous scalp video electroencephalography was performed over 4 days, during which six clinical seizures were associated with electroencephalography changes at the right occipital and temporal lobes. Invasive intracranial video electroencephalography identified a focus at the right occipital lobe, a focus at the right temporal lobe that spread rapidly to the right parietal lobe, and an irritative zone over the posterior part of the right frontal lobe. Functional mapping delineated the motor and sensory cortices. Right temporal lobectomy, right occipitoparietal cortical excision, and multiple subpial transections of the posterior part of the right frontal lobe were performed. For 16 months after the surgery, the patient has been seizure-free while receiving drug treatment, and the only complication reported has been a segmental loss of the left visual field.

Hong Kong Med J 2001;7:97-100

Key words: Brain diseases/surgery; Child; Electroencephalography; Epilepsy, temporal lobe/surgery; Magnetic resonance imaging