Table 2.

Patients with new lesions at 7 T or MRI‐negative with abnormal histopathology

Pat. no.	Sex/age	Age at debut	Semiology	Surface EEG ictal epileptiform discharges	Surface EEG interictal epileptiform discharges	ECOG	MEG	FDG PET	SPECT	1.5 T MRI	3 T MRI	7 T MRI	Surgery	Histopathology (ILEA type)	Outcome (Engel Score)
1	♀/44	26	Focal impaired awareness seizures; hyperkinetic seizures	R frontal parasagittal	R frontal parasagittal	Continuous spiking, R frontal parasagittal	Not performed	No abnormalities	Not performed	Not performed	No abnormalities	Subtle blurring, hyperintensity on DIR R frontal parasagittal	R Partial lobectomy frontal parasagittal	FCD IIb	1A+ 5 years
2	♂/7	4	Focal impaired awareness seizures, R hand automatisms	R frontal	R frontal parasagittal	Continuous spiking R frontal parasagittal	Not performed	No abnormalities	Not performed	Not performed	No abnormalities	R frontal small area with subtle blurring of G/W boundary, subtle white matter hyperintensity (T2)	R frontal lesionectomy	FCD IIa	1A+ ½ year
3	♀/40	24	Focal impaired awareness seizures, dysphasia and alexia; focal to bilateral tonic‐clonic seizures	L temporal	L temporal	Interictal diffuse L temporal, ictal neocortical L mid‐temporal	Spikes neocortex L medial temporal gyrus	No abnormalities	Not performed	No abnormalities a	No abnormalities	Subcortical hyperintensities (FLAIR + T2), blurring of GW‐junction L anterior superior temporal gyrus	Lesionectomy L medial temporal gyrus	mMCD with oligodendroglial hyperplasia	1A+ 1 year
4	♀/22	8	Focal impaired awareness seizures; visual aura; focal to bilateral tonic‐clonic seizures	Onset mid‐frontal	Mid‐frontal	Not performed	Multifocal, at distance from visual cortex	L Occipital hypermetabolism	Not performed	No abnormalities	No abnormalities	Subtle white matter signal changes, transmantle sign‐like configuration L inferior occipital gyrus.	Under evaluation	n/a	n/a
5	♂/21	15	Focal impaired awareness seizures, stops activity, staring, L‐sided version, automatisms	L frontal	L frontal	Continuous spiking L medial frontal gyrus	L frontal epileptic activity	L temporal hypometabolism	L frontal (consistent with 7 T MRI) and less pronounced L parietal	Not performed	No abnormalities a	L frontal operculum/inferior frontal sulcus abnormal gyration and subtle transmantle hyperintensity (WMS), enhanced venous vasculature in sulcus (T2*)	Corticectomy L medial frontal gyrus	mMCD type 2, sample error likely, no examination of center of MRI lesion	1A+ 4 months
6	♂/14	4	Focal impaired awareness seizures, hyperkinetic	L frontal	Ictal onset L frontal	Continuous spiking depth of L superior frontal sulcus (depth electrode)	L frontal spikes	No seizure focus	Not performed	No abnormalities a	No abnormalities	L frontal abnormally deep sulcus with blurring GM‐junction, cortical thickening and subtle transmantle sign	Lesionectomy L middle frontal gyrus	FCD IIb	1A+ 1½ months
7	♂/14	10	Focal impaired awareness seizures, nocturnal seizures with automatisms; bilateral tonic‐clonic seizures	Not performed	L centro‐parietal	Not performed	L parietal epileptic activity	L parietal hypometabolism	Not performed	Not performed	No abnormalities	L parietal radial band of poorly demarcated white matter signal changes	Lesionectomy with ACOG planned	n/a	n/a
8	♀/28	15	Focal impaired awareness seizures, arrest of activity; focal to bilateral tonic‐clonic seizures	L temporal	Bilateral fronto‐centro‐temporal	Planned	Not performed	L temporo‐parietal, angular gyrus hypometabolism	Not performed	No abnormalities a	No abnormalities a	Abnormal intraparenchymal venous pattern posterior L medial temporal gyrus.	Grid planned	n/a	n/a
9	♂/15	11	Focal impaired awareness seizures, L‐sided head version, irresponsiveness, dysphasia, amnesia; focal to bilateral tonic‐clonic seizures	Non‐lateralizing	Multifocal	Diffuse L temporo‐parietal	L baso‐temporal, up to posterior temporal	No abnormalities	Not performed	MTS L + dubious blurring GWM‐junction and decreased volume L temporal	MTS L + dubious blurring GWM‐junction and decreased volume L temporal a	MTS L + abnormal gyration L anterior temporal and enhanced venous vasculature (T2*)	NVS after initial grid registration. Ultimately selective L anterior lobectomy + hippocampectomy	mMCD type 2, no MTS	4B+ ½ year
10	♀/28	0	Focal impaired awareness seizures, automatisms, expressive dysphasia	L mid‐temporal sharp waves	L mid‐temporal spikes	L anterior temporal neocortical + hippocampus	Not performed	L temporal hypometabolism	Not performed	Possible MTS L	MTS L + unclear demarcation of GWM‐junction temporal lobe	MTS L + unclear demarcation of GWM‐junction temporal lobe. No indication of dual pathology	L anterior temporal lobectomy + amygdalahi pocampectomy	MTS ILAE class 2 + FCD IIIa	1A− 1 year
11	♀/15	9	Focal aware seizures, R‐sided version eyes/head; bilateral tonic‐clonic seizures	L fronto‐central	No distinct epileptiform activity	Ictal onset L fronto‐central	L fronto‐central spikes	No abnormalities	Not performed	No abnormalities	No abnormalities	No abnormalities	Lesionectomy L pre‐central, pre‐central sulcus	Normal tissue (suspect for sample error, FCD in bottom of sulcus)	1A− 2 years
12	♂/14	7	Focal impaired awareness seizures, left tonic; focal to bilateral tonic‐clonic seizures	R fronto‐central	R posterior temporal	Continuous spiking R baso‐ temporo‐occipital	R temporal spikes	R baso‐temporo‐occipital hypo‐metabolism	Not performed	No abnormalities a	No abnormalities	No abnormalities (severe signal loss in temporal lobes)	R baso‐temporo‐occipital lesionectomy	FCD IIa	1A− 1 year
13	♂/18	14	Focal impaired awareness seizures hyperkinetic; focal to bilateral tonic‐clonic seizures	No distinct epileptiform activity	No distinct epileptiform activity	No interictal activity, ictal medial frontal gyrus	No abnormalities	R frontal hypometabolism	Not performed	No abnormalities a	Not performed	No abnormalities	Corticectomy R medial frontal gyrus	mMCD type 2	1D+ 5 year
14	♀/22	11	Focal impaired awareness seizures, sensory dysphasia, derealization, sensations in left foot; focal to bilateral tonic‐clonic seizures	R posterior baso‐temporal	R posterior temporal	Bursts R posterior temporal, sporadic spikes R hippocampus	R hemisphere, no clear localization	Dubious hypometabolism R operculum	Not performed	Not performed	No abnormalities	No abnormalities	Resection posterior baso‐temporal, fusiform gyrus	Normal, but suboptimal assessment due to fragmentation	1A+ 1/2 year
15	♂/33	20	Focal impaired awareness seizures, auditory phenomena, R‐sided head version, confusion; focal to bilateral tonic‐clonic seizures	L posterior temporal	Aspecific irregularities bilateral fronto‐temporal	Sporadic spikes L lateral temporal	Not conclusive	L baso‐temporal‐parietal, hypometabolism in large area	Not performed	Not performed	No abnormalitiesa	No abnormalities	Corticectomy L superior and middle temporal gyrus	No abnormalities	1A+ 1 month
16	♂/16	12	Focal impaired awareness seizures, myoclonia all extremities, L‐sided version of eyes followed by diminished vision; bilateral tonic‐clonic seizures	R temporo‐occipital	R temporo‐occipital	Continuous spikes R lateral temporal, sporadic spikes R parietal and lateral and medial temporal	Baso‐temporal/lateral and R posterior insula	R temporo‐occipital hypometabolism	Not performed	No abnormalitiesa	No abnormalities	No abnormalities	R temporal lobectomy	mMCD type 2	Follows

DIR, double inversion recovery sequence; ECOG, electrocorticography; EEG, electroencephalogram; Engel score: 1A, completely seizure free; 1D, only seizures after discontinuation of antiepileptic drugs; +, on antiepileptic drugs; −, antiepileptic drugs discontinued; FDG‐PET, fluorodeoxyglucose (¹⁸F) positron emission tomography; FLAIR, fluid‐attenuated inversion recovery sequence; GW‐junction, gray and white matter junction L, left‐sided; MEG, magnetoencephalogram; MTS, mesiotemporal sclerosis; R, right‐sided.

^aMRI scan performed outside University Medical Center Utrecht.