A 15 year old boy had 10-12 paial complex seizures per day in spite of adequate 4 drug antiepileptic regime. He had history of repeated high grade fever in childhood. MRI for epilepsy protocol revealed normal brain scan. What should be the best non-invasive strategy to make a definite diagnosis so that he can be prepared to undergo epilepsy surgery.
D i.e. Video EEG with ictal 99m TcHMPAO Brain SPECT Any recurrent or resistant (to drugs) seizure activity may be due to non detectable underlying structural lesion (cryptogenic epilepsy). Hippocampal SclerosisQ is the most common structural lesion, which is associated with temporal lobe epilepsy, the most common of the paial epilepsiesQ.
Interictal scalp EEG.
Video EEG
Interictal 18F-FDg PET.
Video EEG with Ictal 99mTc-HMPAO Brain SPECT