case_images: PMC11079211_01
case_images: Ictal EEG from 3-day phase 1 session. EEG results showing seizure onset modified bipolar montage with sub temporal chains, sensitivity 7 microvolts/cm, high cut: 15 Hz, low cut: 1.0 Hz. At 21:12:12 the patient awoke and put right hand over his face. Electrographic onset noted at 21:12:25 with rhythmic theta in the right temporal and subtemporal chains preceded oral automatisms (marked).
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case_images: PMC11079211_01_fneur-15-1391439-g001.jpg
case_images: fig1
case_images: Due to drug resistant seizures, the patient underwent a three-day long video EEG monitoring session, during which a total of 10 right temporal regional focal onset electrographic seizures were captured (onset Figure 1).
case_images: Interictal EEG of right temporal sharp waves. EEG results showing right temporal sharp waves with modified bipolar montage with sub temporal chains, sensitivity 7 microvolts/cm, high cut: 70 Hz, low cut: 1.0 Hz.
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case_images: PMC11079211_01_fneur-15-1391439-g002.jpg
case_images: fig2
case_images: The admission also captured presumed surface negative focal aware seizures with delayed pupillary dilatation and a sensation of being "outside of oneself." Interictally, the EEG demonstrated mild intermittent polymorphic right temporal slowing along with occasional right temporal sharp and spike wave discharges consistent with focal cerebral dysfunction and seizure risk (Figure 2).
case_images: Abnormal MRI with IV Contrast. 2019 MRI brain FLAIR images utilizing a 3 T magnet with intravenous contrast show multiple zones of encephalomalacia due to prior traumatic brain injury and right ventricular catheterization.
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case_images: PMC11079211_01_fneur-15-1391439-g003.jpg
case_images: fig3
case_images: Workup also included a 2019 MRI of the brain with intravenous contrast, showing patchy areas of FLAIR hyperintensities within the bilateral anterior frontal periventricular white matter extending along the forceps minor (Figure 3).
case_images: Final placement of sEEG electrodes under X-ray. Post implantation X-ray showing right hemisphere depth electrode placement.
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case_images: PMC11079211_01_fneur-15-1391439-g004.jpg
case_images: fig4
case_images: This involved the positioning of 11 electrodes targeting specific anatomic locations to localize the seizure onset zone (Figure 4).