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Abstract
Objective: To present a case that demonstrates that seizures and interictal disturbances can be driven by a small area of functionally abnormal cortex.
Methods: Two novel functional MRI network analysis methods were used to supplement conventional seizure and lesion localization methods: (1) regional homogeneity to quantify local connectivity, or synchrony, with a resolution of less than 1 cm3 of cortex; and (2) small-worldness to combine information about whole brain network segregation and integration.
Results: After a small corticectomy in the dominant supramarginal gyrus (13 × 7 × 6 mm) limited to the area of abnormal local connectivity, and smaller than the PET and SPECT abnormalities, the patient has been seizure-free for 3 years with no language deficit. Whole brain network characteristics normalized (small-worldness) to that of healthy controls.
Conclusions: This case demonstrates that small areas of cortex may be highly epileptogenic, drive intractable epilepsy, and disrupt large-scale networks likely to be involved in core cognitive functions.
GLOSSARY
- fMRI=
- functional MRI
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received November 21, 2016.
- Accepted in final form March 1, 2017.
- © 2017 American Academy of Neurology
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