CENTRAL NEOCORTICAL EPILEPSY - HYPOTHESIS AND SURGICAL APPROACH

From a large series of epilepsy surgeries, we identified a spectrum of epileptogenic infarctions involving central neocortex. The severest e nd of this spectrum includes patients with the well-known syndrome of infantile hemiplegia. On magnetic resonance imaging (MRI), they show m ajor hemispheric damage in the middle cerebral arterial distribution w ith or without involvement of other vessels. They usually have widespr ead EEG abnormalities and are best treated with hemispherectomy. The m iddle of this spectrum includes patients with infarction involving one or two branches of the middle cerebral artery (MCA) with varying degr ees of hemiplegia. They can be treated with focal resection of only th e infarcted tissue. The mildest form of this spectrum is represented b y patients showing minimal to no MRI evidence of cerebral infarction a nd minimal to no neurologic deficit, but with histopathologic cortical abnormalities consistent with mild infarction. Such patients are cand idates for multiple subpial transections (MST) when the epileptogenic focus involves indispensable cortex.