Fig. 4

(Case 59, Table 2, group pp., decision type 2.): A drug-resistant epileptic patient with the electroclinical features of a right frontal epilepsy. a Video-EEG monitoring revealed his habitual seizure, a right frontocentral seizure activity was seen, which rapidly became bilateral (marked with red arrows). Concordantly, cranial MRI showed a nodular heterotopia in the right inferior frontal gyrus. b Axial T2 (left), coronal FLAIR (middle) and coronal T1 MPR (right) images. The white arrow on the T2 image and the large black arrows on the FLAIR and T1 images show focal nodular subependymal grey matter heterotopia. The small black arrows on the coronal T1 MPR image (right) show probable migrational bands. c Exceptionally compared to the other cases, during 18F-FDG PET and PET/MRI, a circumscribed FDG accumulation reaching the intensity of cortical tracer uptake (and highly exceeding white matter uptake) can be observed, identically to the right periventricular heterotopia. In this case, resective surgery became available instead of iEEG. Because the patient was left-handed, fMRI and also Wada-test were performed and they proved that in this case, active Broca region is localized in the right hemisphere. Thus, resective surgery was performed in awake state and finally, only a partial resection was possible. After the resective surgery, patient had much shorter (1–3 s long) seizures