Fonseca Natascha C da, Talai Afsaneh, Veltkamp Daniel, Feltrin Fabricio S, Armstrong Dallas, Price Angela, A Maldjian Joseph, Davenport Elizabeth M
Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas 75390 TX, USA.
Department of Radiology, the University of Texas Southwestern Medical Center, Dallas, TX, USA.
Epilepsy Behav Rep. 2025 Mar 12;30:100759. doi: 10.1016/j.ebr.2025.100759. eCollection 2025 Jun.
A case is presented of a 17-year-old right-handed male with drug-resistant epilepsy (DRE), initially presenting with non-lesional MRI findings, where ictal MEG beamforming successfully localized a subtle Focal Cortical Dysplasia (FCD). His seizure onset began at age 13, with episodes evolving into bilateral tonic-clonic seizures. Despite various medication trials and normal initial electroencephalograms, his seizures escalated in frequency and severity by age 16. Subsequent diagnostics were unable to reveal definitive lesions, including a high-resolution MRI and various functional imaging techniques. MEG was performed, capturing two electroclinical seizures but without interictal epileptiform discharges. Frequency-based beamforming analysis localized the seizure onset to the right anterior precuneus and superior parietal lobule. This result prompted a re-evaluation of the same MRI images, revealing subtle cortical abnormalities and pinpointing an FCD. Subsequent stereoelectroencephalography confirmed these findings, and the patient underwent successful Laser Interstitial Thermal Therapy, resulting in seizure freedom. This case highlights the utility of frequency-based ictal MEG beamforming in identifying epileptogenic zones and its potential as a powerful tool in the presurgical assessment of DRE patients and non-invasive identification of subtle FCD, especially when traditional methods are unable to localize.
本文介绍了一名17岁右利手男性耐药性癫痫（DRE）患者，其最初MRI检查无病变表现，发作期MEG波束形成成功定位了一处细微的局灶性皮质发育不良（FCD）。他于13岁开始发作，发作逐渐演变为双侧强直阵挛发作。尽管进行了各种药物试验且初始脑电图正常，但到16岁时，其发作频率和严重程度仍不断升级。后续诊断未能发现明确病变，包括高分辨率MRI和各种功能成像技术。进行了MEG检查，捕捉到两次发作期临床癫痫发作，但无发作间期癫痫样放电。基于频率的波束形成分析将癫痫发作起始部位定位在右侧前楔叶和顶上小叶。这一结果促使对相同的MRI图像进行重新评估，发现了细微的皮质异常并确定了一处FCD。随后的立体定向脑电图证实了这些发现，患者接受了成功的激光间质热疗法，实现了无癫痫发作。该病例突出了基于频率的发作期MEG波束形成在识别致痫区方面的效用及其作为DRE患者术前评估和非侵入性识别细微FCD的有力工具的潜力，尤其是在传统方法无法定位时。
