Dominant, Non-lesional Frontal and Parietal Lobe Epilepsy

This chapter describes a patient with pharmacoresistant non-lesional focal epilepsy who underwent partial precuneus resection and multiple subpial transections due to the overlap of the ictal onset node with functional motor cortex. We discuss various techniques for multiple subpial transections, their indications, and outcomes. We also present the contemporary alternatives to multiple subpial transections (i.e., neuromodulation). We analyze ictal semiologies such as paresthesias, grasping, the Jacksonian march, and focal motor (tonic, clonic, myoclonic) seizures. We shed light on post-ictal Todd’s paresis and pre-ictal premonitory symptoms (prodromes) that are distinct from focal aware seizures (auras). Finally, we discuss the etiologies of cerebellar hypometabolism as well as the factors that contribute to global cerebral atrophy.