{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:56:21Z","timestamp":1790751381325,"version":"4.1.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Lennox\u2013Gastaut syndrome (LGS) is generally regarded as a developmental and epileptic encephalopathy involving distributed brain networks, although a focal structural abnormality may occasionally recruit bilateral cortical and thalamic circuits and produce an LGS phenotype. We characterized the spatiotemporal organization of such a network and its changes after focal SEEG-guided radiofrequency thermocoagulation (RF-TC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 50-year-old woman with drug-resistant epilepsy, multiple seizure types, diffuse slow spike-and-wave discharges, generalized paroxysmal fast activity, intellectual impairment, and right frontal periventricular heterotopia (PVH) underwent stereo-electroencephalography (SEEG). Cortico-cortical evoked potentials (CCEPs) were acquired before and after SEEG-guided radiofrequency thermocoagulation (RF-TC). Resting-state functional MRI (rs-fMRI), obtained before and 3\u202fmonths after RF-TC, was analyzed using three seeds: the entire right frontal PVH and the right and left centromedian thalamic nuclei (CM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SEEG identified the earliest sustained ictal activity within the sampled right frontal PVH-related medial contacts, accompanied by high-frequency activity. This was followed by ipsilateral lateral frontal recruitment, contralateral frontal synchronization, and subsequent bilateral CM involvement. Two-stage RF-TC of the onset and early-recruited networks was followed by seizure freedom through 9\u202fmonths. After RF-TC, right-sided stimulation produced markedly attenuated lesion-related CCEP responses, whereas left-sided responses and responses between thalamic contacts showed little appreciable change. Descriptive rs-fMRI difference maps demonstrated decreased local frontal connectivity around the treated territory and increased long-range connectivity for the PVH seed; both CM seeds showed predominantly increased connectivity with distributed cortical and cerebellar regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this patient, a focal PVH-related epileptogenic network was associated with secondary bilateral cortical and thalamic recruitment underlying an LGS phenotype. CCEP and rs-fMRI captured complementary aspects of postoperative network change: attenuation of stimulation-evoked propagation and postoperative changes in intrinsic functional connectivity, respectively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnins.2026.1961911","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:01:41Z","timestamp":1790748101000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Right frontal periventricular heterotopia underlying secondary network epilepsy with a Lennox\u2013Gastaut phenotype: multimodal SEEG, CCEP, and rs-fMRI evidence"],"prefix":"10.3389","volume":"20","author":[{"given":"Changquan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Functional Neurosurgery, Comprehensive Epilepsy Unit, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University, School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Comprehensive Epilepsy Unit, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University, School of Medicine","place":["Shanghai, China"]},{"name":"Department of Neurosurgery, Clinical Neuroscience Center, Comprehensive Epilepsy Unit, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialin","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University, School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caicai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Comprehensive Epilepsy Unit, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University, School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenzhen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Comprehensive Epilepsy Unit, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University, School of Medicine","place":["Shanghai, China"]},{"name":"Department of Neurosurgery, Clinical Neuroscience Center, Comprehensive Epilepsy Unit, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiwen","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Functional Neurosurgery, Comprehensive Epilepsy Unit, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University, School of Medicine","place":["Shanghai, China"]},{"name":"Department of Neurosurgery, Clinical Neuroscience Center, Comprehensive Epilepsy Unit, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1093\/brain\/awh388","article-title":"The role of periventricular nodular heterotopia in epileptogenesis","volume":"128","author":"Aghakhani","year":"2005","journal-title":"Brain"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1111\/epi.12682","article-title":"Lennox-Gastaut syndrome and phenotype: secondary network epilepsies","volume":"55","author":"Archer","year":"2014","journal-title":"Epilepsia"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/s1474-4422(08)70292-8","article-title":"Lennox-Gastaut syndrome: a consensus approach on diagnosis, assessment, management, and trial methodology","volume":"8","author":"Arzimanoglou","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2296","DOI":"10.1111\/epi.14584","article-title":"Stereo-electroencephalography-guided radiofrequency thermocoagulation in patients with focal epilepsy: a systematic review and meta-analysis","volume":"59","author":"Bourdillon","year":"2018","journal-title":"Epilepsia"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3389\/fneur.2014.00093","article-title":"Network connectivity in epilepsy: resting state fMRI and EEG-fMRI contributions","volume":"5","author":"Centeno","year":"2014","journal-title":"Front. 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