"Epilepsy Associated with Periventricular Nodular Heterotopia: Case Report"

Abstract

Introduction: Malformations in cortical development are due to anomalies during the formation of the cortical plaque in intrauterine life. These changes can occur in the stages of proliferation, migration or organization. Abnormal neuronal migration results in heterotopy. Periventricular nodular heterotopy consists of the atypical presence of gray matter in the periventricular white matter. It is estimated that approximately 80% of patients with this malformation develop epilepsy. Bearing in mind that epileptic seizures tend to significantly affect the quality of life of patients, understanding the severity and consequences associated with cortical malformations becomes essential to direct medical care. Thus, the objective of the present article is to report the case of a patient with epilepsy associated with periventricular nodular heterotopy, and through this to propose a discussion regarding the main evidence available in the literature that touches both clinical conditions.Case Report: LML, a 31-year-old woman with a history of tonic-clonic seizures that began 2 years ago. Magnetic resonance imaging of the skull showed nodules with a signal similar to the gray matter diffusely distributed below the eppendymum, suggesting heterotopy.Discussion: Although heterotopic nodules seem to act as a focus of abnormal neuronal activity, their role in epileptogenicity remains controversial. While electrophysiological studies demonstrate that they can be intrinsically epileptogenic, others indicate that a large epileptic network, rather than just a nodule, is responsible for epileptogenicity. Conclusion:Malformations in cortical development represent an important comorbidity associated with the genesis of epilepsy. Even so, prospective electrophysiological studies are necessary to elucidate the pathophysiological mechanisms involved in this process.