{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T12:54:41Z","timestamp":1782132881507,"version":"3.54.5"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Despite formal recognition of \u201ccombined generalized and focal epilepsy\u201d in the 2017 International League Against Epilepsy classification, its implications for therapeutic decision\u2010making remain ambiguous. We report a case demonstrating how focal cortical pathology can interact with distributed epileptic networks using multimodal electrophysiology. A patient with long\u2010standing presumed generalized epilepsy and a left frontal malformation of cortical development (MCD) underwent multimodal evaluation with simultaneous scalp electroencephalography\u2013stereoelectroencephalography (SEEG; left frontal lesion\u2010targeted implantation with a right frontal sentinel electrode) and simultaneous SEEG\u2013magnetoencephalography (MEG). Simultaneous scalp EEG and SEEG demonstrated generalized spike\u2013wave (GSW) discharges with bilateral frontal and thalamic involvement, without focal interictal epileptiform activity at the lesion site. Direct cortical stimulation of SEEG contacts adjacent to the MCD reproduced habitual seizures, producing localized afterdischarges followed by widespread thalamocortical engagement and delayed focal cortical evolution. Simultaneous SEEG\u2013MEG recordings of GSWs revealed early posterior hemispheric involvement with subsequent frontal recruitment, supporting a distributed network mechanism. Left frontal MCD resection was associated with elimination of convulsive seizures, with persistent thalamic spike\u2013wave activity recorded by a responsive neurostimulator that remained inactive for stimulation. Together, these findings demonstrate the limitations of fixed dichotomous focal\u2013generalized distinctions and highlight the value of network\u2010based approaches to epilepsy classification and surgical treatment.<\/jats:p>","DOI":"10.1002\/epi.70249","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T13:31:29Z","timestamp":1777296689000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Insights from multimodal simultaneous SEEG\u2010EEG and SEEG\u2010MEG recordings: A case of combined generalized and focal epilepsy"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6770-9642","authenticated-orcid":false,"given":"Thandar","family":"Aung","sequence":"first","affiliation":[{"name":"Department of Neurology University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9377-7524","authenticated-orcid":false,"given":"Katsiah","family":"Cadet","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2074-4245","authenticated-orcid":false,"given":"Lazarus","family":"Mayoglou","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6327-7811","authenticated-orcid":false,"given":"Umit","family":"Aydin","sequence":"additional","affiliation":[{"name":"School of Psychology and Clinical Language Sciences University of Reading  Reading UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6754-8597","authenticated-orcid":false,"given":"Ajay","family":"Niranjan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6284-8336","authenticated-orcid":false,"given":"Anto I.","family":"Bagi\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13709"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1981.tb06159.x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.18338"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02074.x"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2023.11.016"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebr.2022.100555"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2015.10.005"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02045.x"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010024\u201012841\u2010z"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.5455\/medarh.2021.75.462-466"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0013-9580.2004.45003.x"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2005.10.004"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02092.x"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/0013-4694(52)90079-5"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200108023450501"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2013.209"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0013-4694(95)00064-6"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/879716"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1006\/nimg.1998.0395"},{"key":"e_1_2_12_21_1","unstructured":"FreeSurfer software suite. 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Available from:http:\/\/surfer.nmr.mgh.harvard.edu"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/44\/2\/010"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1109\/10.141192"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.831546"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000213567"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1103\/RevModPhys.65.413"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi.70249","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/epi.70249","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi.70249","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T12:25:15Z","timestamp":1782131115000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epi.70249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/epi.70249"],"URL":"https:\/\/doi.org\/10.1002\/epi.70249","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]},"assertion":[{"value":"2025-12-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}