Confirmation of Two Magnetoencephalographic Epileptic Foci by Invasive Monitoring from Subdural Electrodes in an Adolescent with Right Frontocentral Epilepsy

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Abstract
Summary: Purpose: To report our evaluation of interictal two epileptic spike fields on magnetoencephalography (MEG) by using invasive intracranial monitoring in a patient without lesion on magnetic resonance imaging (MRI). Methods: A 15‐year‐old left‐handed boy with a 9‐year history of refractory simple partial seizures, secondarily generalized, and a normal MRI, was studied with MEG to define magnetic spike sources, followed by invasive intracranial monitoring with subdural electrodes to delineate the epileptogenic zone and eloquent function pursuant to focal cortical excision. Results: MEG demonstrated two spike foci on the right middle frontal and inferior rolandic areas adjacent to the st sory area. Ictal recordings during prolonged invasive monit ing from subdural electrodes revealed two epileptogenic zoi in the same locations as those defined by MEG. Focal corti excision was performed of each epileptogenic zone. The patii has been seizure free for 24 months without neurologic deficit Conclusions: Magnetic source imaging is a valuable adjui in the planning of subdural grid placement in epilepsy surge particularly in patients in whom conventional imaging fails reveal a lesion.