Dominant, Lesional Temporal Lobe Epilepsy

This chapter discusses a case of pharmacoresistant dominant temporal lobe epilepsy due to a partially resected cavernous angioma. This case emphasizes the importance of extra-operative functional mapping in establishing the resection margins. We provide an overview of cortices critical for linguistic tasks. We also explore the importance of handedness in determining hemispheric language dominance and the elements that contribute to language reorganization. We briefly review the literature regarding afterdischarges elicited during direct cortical stimulation. Furthermore, we summarize the data on responsive neurostimulation (RNS) system (NeuroPace®. Mountain View, CA) in neocortical epilepsy, its short- and long-term effects, as well as its associated complications. We examine the most recently proposed hypothesis (network reorganization) regarding the therapeutic effect of the RNS system®. We also highlight the most recent evidence regarding network synchronizability, measured by functional connectivity at different frequency bands, as a potential predictive biomarker in RNS system® therapy. Lastly, we analyze semiologies such as ictal tachycardia and ictal aphasia.