Child's Nervous System

, Volume 34, Issue 6, pp 1267–1269 | Cite as

Bottom-of-sulcus focal cortical dysplasia presenting as epilepsia partialis continua multimodality characterization including 7T MRI

  • Sarah A. Kelley
  • Shenandoah Robinson
  • Nathan E. Crone
  • Bruno P. Soares
Case Report



Bottom-of-sulcus focal cortical dysplasias are an under recognized, surgically treatable cause of focal epilepsy. Resection can dramatically reduce the seizure burden for children with refractory epilepsy, or eliminate seizures altogether.

Material and Methods

We report the case and present the results of multimodality evaluation of a 15-year-old young man who presented with long-standing partial epilepsy affecting his right leg, which over the years became refractory to therapy.


High-resolution 3T MRI images acquired as a dedicated epilepsyprotocol were initially interpreted as unremarkable. On further review by an experienced specialist aware of clinical and electroencephalographic findings, a subtle focal cortical dysplasia was identified at the bottom of a sulcus near the medial aspect of the left precentral gyrus. After confirmation of the extent of the lesion with PET and ultra-high field 7T MRI, the patient underwent cortical mapping and focal resection and remains free of seizures.


This case emphasizes the need for a multidisciplinary approach to the evaluation of refractory focal epilepsy in children and highlights the potential role of ultra-high field 7T MRI in identifying the often subtle causative anatomic abnormalities.


Focal cortical dysplasia Epilepsia partialis continua Pediatric epilepsy Brain MRI 



We would like to thank Dr. Michael V. Johnston for facilitating access to 7T neuroimaging and Professors Peter van Zijl and Peter B. Barker for the assistance with imaging acquisition and post-processing.

Author contributions

All authors made substantial contribution to the patient’s clinical care and data collections, had full access to all the data in the study, and take responsibility for the integrity of the data and the accuracy of the analysis. All authors were involved in study concept and design. SAK and BPS were involved in acquisition of data and in drafting of the manuscript. All authors were involved in critical revision of the manuscript for important intellectual content.

Compliance with ethical standards

Conflict of interest


Patient consent


Provenance and peer review

Not commissioned; externally peer reviewed.


  1. 1.
    Besson P, Andermann F, Dubeau F, Bernasconi A (2008) Small focal cortical dysplasia lesions are located at the bottom of a deep sulcus. Brain 131(Pt 12):3246–3255CrossRefPubMedGoogle Scholar
  2. 2.
    Harvey AS, Mandelstam SA, Maixner WJ, Leventer RJ, Semmelroch M, MacGregor D, Kalnins RM, Perchyonok Y, Fitt GJ, Barton S, Kean MJ, Fabinyi GCA, Jackson GD (2015) The surgically remediable syndrome of epilepsy associated with bottom-of-sulcus dysplasia. Neurology 84(20):2021–2028CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hofman PA, Fitt GJ, Harvey AS et al (2011) Bottom-of-sulcus dysplasia: imaging features. AJR Am J Roentgenol 196(4):881–885CrossRefPubMedGoogle Scholar
  4. 4.
    De Ciantis A, Barba C, Tassi L et al (2016) 7T MRI in focal epilepsy with unrevealing conventional field strength imaging. Epilepsia 57(3):445–454CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sarah A. Kelley
    • 1
  • Shenandoah Robinson
    • 2
  • Nathan E. Crone
    • 1
  • Bruno P. Soares
    • 3
  1. 1.Department of NeurologyJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA

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