Case Report: Focal, generalized, or both: does generalized network involvement preclude successful epilepsy surgery?

TL;DR

Two patients with focal epilepsy and generalized EEG features successfully underwent surgery and became seizure-free.

Contribution

Demonstrates that generalized EEG patterns in focal epilepsy do not exclude successful surgical outcomes.

Findings

Focal cortical resection led to long-term seizure freedom in both patients.

Generalized EEG features resolved after successful surgery in focal epilepsy cases.

Abstract

We present two cases with focal seizures where scalp electroencephalography (EEG) had prominent features of a developmental and epileptic encephalopathy (DEE): Case 1: a 17-year-old male with complex motor seizures whose EEG demonstrated a slow spike-and-wave pattern and generalized paroxysmal fast activity (GPFA). Case 2: a 12-year-old male with startle-induced asymmetric tonic seizures whose EEG also had a slow spike-and-wave pattern. Both patients had intracranial EEG assessment, and focal cortical resections resulted in long-term seizure freedom and resolution of generalized findings. These cases exemplify patients with focal epilepsy with networks that share similarities to generalized epilepsies, and importantly, these features did not preclude curative epilepsy surgery.

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