Non-dominant, Lesional Frontal and Temporal Lobe Epilepsy

This chapter presents a patient with clinical features of neurofibromatosis type I and pharmacoresistant epilepsy due to temporal and frontal lobe encephaloceles secondary to an intracranial osseous defect. We discuss the pathogenesis of encephaloceles, their presentation, neuroimaging findings, surgical interventions, and outcomes. We briefly address the difference between meningoceles, meningoencephaloceles, encephaloceles, and arachnoid granulations or pits with and without herniated cerebral parenchyma. We also highlight the different diagnostic work-up necessary in patients with encephalocele, including evaluation for genetic causes and assessing intracranial pressure. We discuss semiologies such as versive and non-versive head deviation, early and late head turn, gaze deviation, ictal dystonia, automatism, gyration, rhythmic ictal non-clonic hand movements, and the last clonic movement.