A 4-year-old male with drug-resistant focal epilepsy, secondary to tuberous sclerosis. His seizures started at 3 months of age with generalized epileptic spasms and evolved to stiffening of left arm, smiling and eye movements. Frequency ranges from 3-4 times per week to 1-2 per day. No status epilepticus was documented.

On EEG, the vast majority of electrographic and electroclinical seizures were captured from the right frontal or frontocentral or central-parietal regions.

MRI showed a high burden of tubers, corresponding to hypometabolic areas in 18F-FDG-PET, with no sure localization of the epileptogenic focus. So, stereo EEG implantation was considered for surgical planning.

Courtesy of Dr. Christine Saint-Martin, Associate Professor in the Neuroradiology and Pediatric Radiology at McGill University.