A novel technique of detecting MRI-negative lesion in focal symptomatic epilepsy: Intraoperative ShearWave Elastography
Article first published online: 1 MAR 2014
Wiley Periodicals, Inc. © 2014 International League Against Epilepsy
Volume 55, Issue 4, pages e30–e33, April 2014
How to Cite
Epilepsia, 55(4):e30–e33, 2014
- Issue published online: 22 APR 2014
- Article first published online: 1 MAR 2014
- Manuscript Accepted: 9 JAN 2014
- Focal epilepsy;
- Shear wave;
- Cortical dysplasia;
- Intraoperative ultrasound
Focal symptomatic epilepsy is the most common form of epilepsy that can often be cured with surgery. A small proportion of patients with focal symptomatic epilepsy do not have identifiable lesions on magnetic resonance imaging (MRI). The most common pathology in this group is type II focal cortical dysplasia (FCD), which is a subtype of malformative brain lesion associated with medication-resistant epilepsy. We present a patient with MRI-negative focal symptomatic epilepsy who underwent invasive electrode recordings. At the time of surgery, a novel ultrasound-based technique called ShearWave Elastography (SWE) was performed. A 0.5 cc lesion was demonstrated on SWE but was absent on B-mode ultrasound and 3-T MRI. Electroencephalography (EEG), positron emission tomography (PET), and magnetoencephalography (MEG) scans demonstrated an abnormality in the right frontal region. On the basis of this finding, a depth electrode was implanted into the lesion. Surgical resection and histology confirmed the lesion to be type IIb FCD.
A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.