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“Before surgery, we could never convince our radiologist that this was abnormal,” said Dr. Jackson. “But because we believe these small BOSDs could cause this sort of epilepsy, we convinced our surgeon to take a tiny resection … that just took out [an] area of abnormal connectivity.”
The surgery was so precise that Rachel has been seizure-free for nearly three years, reported Dr. Jackson. “We did quite a remarkable job of taking out exactly that bit and only that bit within the middle of her language area,” he said. “When [Rachel] came out of the anesthetic, she was much more interactive, and [we] noticed the personality change.… She did not have that delay we often see in patients, even though she was on the same medications.”
“Really tiny bits of the brain can drive pretty nasty epilepsy,” said Dr. Jackson. Since Rachel’s procedure, she has graduated college and earned her first degree. “I published this [research] just to make the point that not all epilepsy [cases] are like this, but there are some, and we should try to find them.”
—Fred Balzac
Suggested Reading
Abou-Hamden A, Lau M, Fabinyi G, et al. Small temporal pole encephaloceles: a treatable cause of “lesion negative” temporal lobe epilepsy. Epilepsia. 2010;51(10):2199-2202.
Hofman PA, Fitt GJ, Harvey AS, et al. Bottom-of-sulcus dysplasia: imaging features. AJR Am J Roentgenol. 2011;196(4):881-885.
Jackson GD, Pedersen M, Harvey AS. How small can the epileptogenic region be?: a case in point. Neurology. 2017;88(21):2017-2019.
Jackson GD, Berkovic SF, Duncan JS, et al. Optimizing the diagnosis of hippocampal sclerosis using MR imaging. AJNR Am J Neuroradiol. 1993;14(3):753-762.
Jackson GD, Berkovic SF, Tress BM, et al. Hippocampal sclerosis can be reliably detected by magnetic resonance imaging. Neurology. 1990;40(12):1869-1875.
Pillay N, Fabinyi GC, Myles TS, et al. Parahippocampal epilepsy with subtle dysplasia: A cause of “imaging negative” partial epilepsy. Epilepsia. 2009;50(12):2611-2618.
