Intractable focal epilepsy contralateral to the side of facial atrophy in Parry–Romberg syndrome

We report an unusual case of Parry–Romberg syndrome in which medically refractory focal epilepsy with ongoing epilepsia partialis continua (EPC) arose from the hemisphere contralateral to the side of facial atrophy. Unilateral cerebral involvement was confirmed by multi-modal brain imaging, as well as by electroencephalography (EEG) and magnetoencephalography (MEG). While in many cases of Parry–Romberg syndrome, the side of cerebral involvement is ipsilateral to that of the cutaneous lesion, these “discordant” exceptions imply that other yet undefined mechanisms may be responsible for the distribution of the cutaneous and cerebral pathologies.     

Utility of temporally-extended signal space separation algorithm for magnetic noise from vagal nerve stimulators

ObjectiveTo evaluate the utility of a temporally-extended signal space separation algorithm (tSSS) for patients with vagal nerve stimulator (VNS).MethodsWe evaluated median nerve somatosensory evoked responses (SER) of magnetoencephalography (MEG) in 27 VNS patients (48 sides) with/without tSSS processing. We classified SER dipoles as ‘acceptable’ if: (A) the location of the dipole was in the expected location in the central sulcus, and (B) the goodness of fit value (GOF) was greater than 80%. We evaluated (1) the number of sides which produced acceptable dipoles in each dataset (i.e. with/without tSSS processing), and in cases where the both data produced reliable dipoles, (2) compared their GOFs and the 95% confidence volumes (CV) (mm³). Statistical differences in the GOF and CV between with/without tSSS conditions were determined by paired t test.ResultsOnly 11 (23%) responses had reliable dipoles without tSSS processing, while all 48 (100%) had acceptable dipoles under tSSS processing. Additionally, the latter group had significantly higher GOF (increased by 7% on average) and lower CV (mean decrease of 200 mm³) than the former (p < 0.01).ConclusionsProcessing with tSSS quantitatively improves dipole fitting of known sources in VNS patients.SignificanceThis algorithm permits satisfactory MEG testing in the relatively commonly encountered epilepsy patient with VNS.