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SEEG in Polymicrogyria: When and How? 

SEEG in Polymicrogyria: When and How?
Chapter:
SEEG in Polymicrogyria: When and How?
Author(s):

Louis Maillard

, and Georgia Ramantani

DOI:
10.1093/med/9780198714668.003.0019
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date: 23 October 2019

Polymicrogyria (PMG) is one of the most common malformations of cortical development (MCDs), with epilepsy affecting most patients. PMG-related drug-resistant epilepsy patients can be considered for surgery in well-selected cases. In this context, a comprehensive presurgical evaluation, often including stereo electroencephalography, is warranted to accurately delineate the epileptogenic zone. The heterogeneity of intrinsic epileptogenicity in the PMG, together with the additional or predominant involvement of remote cortical areas, calls for a different strategy in PMG compared with other MCDs, one that is not predominantly MRI- but rather SEEG-oriented. Favourable results in terms of seizure freedom and antiepileptic drug cessation are feasible in a large proportion of patients with unilateral PMG. PMG extent should not exclude the possibility of epilepsy surgery. On the other hand, patients with hemispheric PMG can be excellent hemispherotomy candidates, particularly in the presence of contralateral hemiparesis. Recent findings support early consideration of surgery in PMG-related drug-resistant epilepsy.

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