Bilateral Lesional Epilepsy

We present a patient with pharmacoresistant epilepsy due to bilateral periventricular heterotopia who underwent implantation of responsive neurostimulation (RNS) System®. We describe our stepwise two-staged intracranial monitoring approach for lateralizing, regionalizing, and later localizing the areas of ictal onset. We provide a summary of the described surgical strategies for treating patients with intractable epilepsy due to periventricular nodular heterotopia, along with their respective rationales. In addition, the epileptogenesis in patients with periventricular nodular heterotopia and the connectivity between the heterotypic nodules and the overlying cortex and distant foci are briefly discussed. We conclude by analyzing semiologies, such as ictal paresthesias.