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Chronic cortical stimulation for intractable focal reflex epilepsy
A 28-year-old right-handed man presented with medically intractable focal reflex epilepsy. He previously underwent resection of a right parietal lobe cortical dysplasia. Postoperatively, he developed focal reflex epilepsy triggered by motor activation of the left lower extremity. These were refractory to multiple antiepileptic drugs (AEDs) and vagal nerve stimulation therapy (VNS), and prevented standing and walking. Clinical examination showed mild left hemiparesis and left lower extremity myoclonic seizures triggered by motor activation and standing (see online supplementary video 1). Scalp EEG showed focal seizure discharges consisting of rhythmic midline central sharp waves. Brain MRI showed postoperative signal hyperintensity in the region of the prior resection (figure 1A). Subtraction ictal single-photon emission CT coregistered to MRI (SISCOM) demonstrated ictal hyperperfusion in the near prior resection cavity in leg motor area (figure 1B).