Epilepsy

A middle-aged gentleman presents with seizures starting about a decade ago. Despite trying different cocktails of antiepileptics, the seizures are never fully controlled, and the side effects become intolerable. MRI is grossly normal. Continuous EEG captures some of the seizure activity and localize it to the temporal lobe for a presumed diagnosis of mesial temporal lobe sclerosis. However, because imaging is underwhelming, a decision is made by a multidisciplinary group of neurologists and neurosurgeons to proceed with invasive intracranial monitoring prior to temporal lobe resection. They want to be completely sure of the origin of the seizures before removing part of the brain. But invasive epilepsy monitoring is not a benign procedure either. After taking off the skull, the neurosurgeon works closely with the epilepsy specialists to place electrodes directly onto the surface of the brain. These electrodes are more sensitive and specific in localizing seizure foci than surface electrodes placed on the skin. Watching the surgeons work and the neurologists test the leads reminds me how incredible some things we do are.

EEG image shown under Creative Commons Attribution Share-Alike License.