Nonlesional epilepsy—a case report in adult epileptology

We report the case of a patient with nonlesional, pharmacoresistant epilepsy. Bilateral synchronous discharges as well as focal discharges were identified on electroencephalogram (EEG). After non-invasive and invasive presurgical evaluation, a probable epileptogenic zone was identified with concordant results of focal origin involvement of the left temporal pole. Resective epilepsy surgery provided seizure freedom (last follow-up at 12 months). The case nicely illustrates that bilateral synchronous discharges or/and a lack of lesions on neuroimaging are not contraindications to presurgical evaluation of epilepsy, which on the contrary should be offered to all patients with pharmacoresistant epilepsy. The case also illustrates the importance of combining electrophysiological, imaging, and neuropsychological information to guide intracranial EEG placement and improve postsurgical outcome.