PMC8249776_01
Heterogeneous interictal epileptiform discharges. A: Left temporal sharp wave. B: Left frontotemporal sharp wave. C: Left orbitofrontal sharp wave. High pass filter: 1 Hz. Low pass filter: 70 Hz. Sensitivity: 10 microV/mm.
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Long-term video-EEG monitoring revealed heterogeneous interictal epileptiform discharges (IEDs) in the left temporal, frontotemporal and orbitofrontal regions (Fig. 1).
Illustrations of two independent ictal onsets, depth electrode localization and post-ablation lesions. A: left hippocampal ictal onset (LHD7, 8) with propagation to the left anterior temporal (LAT1, 2) and basal temporal (LMT 1, 2) regions. B: Left orbitofrontal ictal onset (LOF1) with propagation to the left hippocampus (LHD8). C: 3D co-registration (bottom view) of pre-implant brain MRI with post-implant head CT using Curry software version 8 (Compumedics, Charlotte NC. USA). RHD, right hippocampal depth; LHD, left hippocampal depth; LAT, left anterior temporal; LMT, left mid-temporal; LPT, left posterior temporal; LOF, left orbitofrontal. Hippocampal depth electrodes were placed through occipital approach with contact 1 in the furthest anterior orientation. Lateral temporal depth electrodes were placed through the orthogonal approach with contact 1 in the furthest mesiotemporal orientation. Orbitofrontal depth electrode was placed through the oblique approach with contact 1 in the furthest mesiobasal frontal orientation. E: Post-contract brain MRI showing the post-ablation lesion in the left amygdalohippocampal complex (red arrow). F: Post-contract brain MRI showing the post-ablation lesion in left orbitofrontal region (red arrow). RHD: right hippocampal depth; LHD: left hippocampal depth; LOF: left orbitofrontal; LAT: left anterior temporal; LMT: left mid-temporal; LPT: left posterior temporal. High pass filter: 1 Hz. Low pass filter: 70 Hz. Sensitivity: 100 microV/mm.
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Independent seizure foci were observed in the left hippocampus and the left orbitofrontal cortex (Fig. 2).