Non-dominant, Lesional Frontal Lobe Epilepsy in the Vicinity of Motor Cortex

This chapter presents a case of pharmacoresistant epilepsy due to a non-dominant frontal demyelinating lesion. We describe the stepwise surgical approach for patients with lesional frontal lobe epilepsy in the vicinity of the motor cortex. We explore the potential role of the subthalamic nucleus as a therapeutic stimulation target in focal motor seizures. We analyze the occurrence of multiple sequential patterns resembling ictal onset patterns during ictal propagation and asymmetric ictal termination. This chapter highlights the significance of extra-operative functional motor mapping in identifying resection margins. We also describe the reorganization of cortices critical for motor function following cortical insults identified via functional MRI, diffusion tensor imaging, and direct cortical stimulation. In addition, we discuss the significance of triggered seizures during high frequency cortical stimulation and their relationship to post-operative outcomes. Lastly, we examine the anatomical boundaries of the supplementary motor areas, the surgical outcome in patients with seizures originating from the supplementary motor areas, and their prognosis and associated complications.