Dominant, Lesional Posterior Quadrant Epilepsy

This chapter presents a patient with dominant left posterior quadrant pharmacoresistant epilepsy due to unilateral periventricular nodular heterotopia and focal cortical dysplasia undergoing MRI-guided laser thermoablative therapy. We highlight the efficacy of MRI-guided laser thermoablative therapy in patients with pharmacoresistant epilepsy due to cortical malformations. We address the role of interictal epileptiform discharges in the surgical decision-making process. We briefly discuss the significance of the ictal high-frequency oscillations in predicting surgical outcome. We present some of the mechanisms underlying the initiation and propagation of seizures with diffuse onset ictal patterns during intracranial monitoring. Lastly, we analyze semiologies such as cephalic auras, language and speech disturbances, ictal vocalization, the “figure of four” sign, and the last clonic movement.