PMC8497699_01
(A) Three-dimensional (3D) MRI showing bilateral periventricular heterotopia and overlying polymicrogyria. (B) T2 Flair of MRI showing asymmetry bilateral periventricular heterotopia and overlying polymicrogyria.
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F1
MRI of his brain showed bilateral periventricular heterotopia with overlying polymicrogyria of the bilateral temporal lobes (Figure 1).
PMC8497699_02
(A) Pre-radiofrequency thermocoagulation (RFTC) 3D reconstruction MRI showing bilateral gray matter nodular heterotopia (GMNH), arrow. (B) Reconstruction of electrodes superimposed on GMNH.
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F2
No electrodes were implanted in the heterotopic area of the left side because the onset of the seizures and clinical signs were completely on the right side, although there was obvious heterotopia on the left side too (Figure 2).
(A) Ictal high-frequency oscillation (HFO) of the stereotactic-electroencephalogram (SEEG), post-GMNH showing HFO (ripple), arrow. (B) Time frequency showing direct current (DC) shift and HFO, maximum at 300 Hz of the initiation discharge of SEEG. Hipp, hippocampus; GMNH A, anterior part of heterotopia; GMNH M, middle part of heterotopia; GMNH P, posterior part of heterotopia; GMNH O, occipital lobe part of heterotopia.
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F3
Following closely (1 s), the contacts that were within and around the middle of the heterotopia demonstrated a fast rhythm (Figure 3).
(A) Follow-up for 58 months, 3D MRI showing a trace of RFTC at the post-GMNH every year from 2016 to 2019. (B) T2 Flair of MRI showing a trace of RFTC at the POST-GMNH and overlying cortex. Blue colored arrow showing a trace of RFTC.
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F4
The EEG results have been normal, and the post-RFTC MRI clearly showed the RFTC site (Figure 4).