Jessica R Fesler, Saad Kanaan, Timothy B Mapstone and Yu-Tze Ng
Pediatric epilepsy patients with generalized or multifocal abnormalities on electroencephalogram and developmental delay have not classically been considered surgical candidates, even if neuroimaging revealed a lesion. A new paradigm advocates for early focal epilepsy surgery, despite non-localizing EEG abnormalities. This is an instructive case of curative focal subcortical heterotopia resection in a six-year-old boy with refractory, symptomatic generalized epilepsy who fit criteria for Lennox-Gastaut syndrome. Post-surgery, he had normalization of his EEG, resolution of behavioral problems and developmental delay, and no seizure recurrence off all antiepileptic medications. Literature is reviewed in the context of this demonstrative case supporting that generalized electrographic and clinical expression of focal pathology may occur beyond infancy and the principle of secondary epileptogenesis. Epileptic encephalopathy may be reversible with resection of a focal lesion and there is potential for cure if patients are given early surgical consideration.