PMC8548742_01
(A) The interictal and ictal scalp VEEG. Scalp VEEG showed seizure onset with stiffening of right limb, apnea, salivation, waving of left limb. (B) SEEG showed all the inter-ictal discharges were located in insular-opercular cortex (J2-3/5-6, M2-5, G2-3/8-9, 01-2/12-13). (C) SEEG showed that the seizures onset zones originated from the insular-opercular cortex (J1-6, G1-2, M1-6, N1-7) with spike-wave in fast activities. The Semiology is stiffening of right limb, apnea, salivation, waving of left limb. (D) MRI images of the patient before the first intracranial electrode implantation. (E) The position of twelve electrodes.
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F1
The VEEG recorded several seizures without heart rate abnormalities, and results of VEEG are displayed in Figure 1A. The MRI showed no obvious abnormalities (Figure 1D), which was evaluated by a neuroradiologist and neurosurgeon. To validate the seizure onset zone, 12 intracranial electrodes surrounding left sylvian fissure were stereotaxically implanted and their positions are shown in Figure 1E. The SEEG monitoring continued for 2 days during which 13 seizures were recorded, and the results of SEEG are displayed in Figures 1B,C.
(A) The MEG ECD method delineated epileptic zone at right posterior cingulate cortex. (B) The MEG STOUT method delineated epileptic zone at the left insular long gyrus of island and the parietal opercula. Thirteen spikes were marked in this patient and Source localization was conducted using ECD and STOUT on each spike within a -100 to 100 ms time window around the peak spike signal. All results displayed over the corticalsur face are thresholded at 50% of the maximum amplitude. As ECD method assumes that a small number of focal sources exist that can be equivalent to a few current dipoles in the brain, the result of MEG ECD method is localized to right posterior cingulate cortex. And the STOUT method is localized to the left insular long gyrus of island and the parietal opercula through localization bias compensation. (C) The position of eight intracranial electrodes.
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F2
MEG ECD showed that the epileptogenic zone was located in the right posterior cingulate cortex (Figure 2A). Eight intracranial electrodes densely covering the insula and insulo-opercular were implanted, and their positions are shown in Figure 2C. The MEG STOUT method delineates the epileptic zone in the insular long gyrus, and the parietal opercula (Figure 2B) covered the epileptogenic zone determined by the original SEEG.
(A) SEEG showed that all the inter-ictal discharges were located in the insular and insular-opercular cortex (N1-6, 02-7, P2-4, R1-3, V2-4, Q5-9, K1-2/7-8, M1-3/6-8). (B) The onset zone also originated from the insular and insular-opercular cortex (Q3-9, R1-8, N2-8, V2-4, P2-4) with spike:waves in fast activities. (C) SEEGs for the inter-ictal discharges were located in the insula (N2-4/6-9,V1-3). (D) The onset zone originated from the insular and insular-opercular cortex (N7-9/2-3, Q7-10, V2-6, R2-4) with spike:waves in fast activities. (E) Images 1 year after RF-TC showed a satisfying ablation.
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Figure 3A shows that SEEGs for all the inter-ictal discharges were located in the insular and insulo-opercular cortex (N1-6, O2-7, P2-4, R1-3, V2-4, Q5-9, K1-2/7-8, M1-3/6-8). The onset zone also originated from the insular and insulo-opercular cortex (Q3-9, R1-8, N2-8, V2-4, P2-4) with spike-waves in fast activities (Figure 3B). Figure 3C shows that SEEGs for the inter-ictal discharges were located in the insula (N2-4/6-9, V1-3). The onset zone originated from the insular and insulo-opercular cortex (N7-9/2-3, Q7-10, V2-6, R2-4) with spike-waves in fast activities (Figure 3D). MRI image of the patient showed a satisfying ablation and was shown in Figure 3E.