Background: For patients with difficult-to-lateralize temporal lobe epilepsy, the use of chronic recordings as a diagnostic tool to inform subsequent surgical therapy is an emerging paradigm that has been reported in adults but not in children.
Observations: The authors reported the case of a 15-year-old girl with pharmacoresistant temporal lobe epilepsy who was found to have bitemporal epilepsy during a stereoelectroencephalography (sEEG) admission. She underwent placement of a responsive neurostimulator system with bilateral hippocampal depth electrodes. However, over many months, her responsive neurostimulation (RNS) recordings revealed that her typical, chronic seizures were right-sided only. This finding led to a subsequent right-sided laser amygdalohippocampotomy, resulting in seizure freedom.
Lessons: In this case, RNS chronic recording provided real-world data that enabled more precise seizure localization than inpatient sEEG data, informing surgical decision-making that led to seizure freedom. The use of RNS chronic recordings as a diagnostic adjunct to seizure localization procedures and laser ablation therapies in children is an area with potential for future study.
Keywords: ASM = antiseizure medication; EEG = electroencephalography; MRI = magnetic resonance imaging; MRg-LITT = MRI-guided stereotactic laser interstitial thermal therapy; MTLE = mesial temporal lobe epilepsy; RNS = responsive neurostimulation; amygdalohippocampotomy; laser ablation; lateralization; pediatric epilepsy; responsive neurostimulation; sEEG = stereo EEG.
© 2022 The authors.