Surgical Treatment of Epileptic Encephalopathy with Spike-and-Wave Activation in Sleep Associated with Polymicrogyria: A Case Report

INTRODUCTION: Epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS) is a rare childhood-onset epileptic encephalopathy, defined by a typical electrographic pattern with mostly continuous slow spike-wave complexes during non-REM sleep. It may be cryptogenic or secondary to genetic or structural etiology. It might be related to progressive and irreversible cognitive deterioration; under these circumstances, there is an urgency for fast adequate treatment. Polymicrogyria is a common brain malformation and epilepsy can occur in up to 90% of the patients. Extensive polymicrogyria can be a cause of EE-SWAS and treatment refractoriness. In these patients, surgical treatment might be considered. CASE PRESENTATION: We report on an 8-year-old child who presented with electrographic findings compatible with EE-SWAS and hemiparesis associated with right hemispheric polymicrogyria who successfully underwent hemispherectomy as primary treatment. Surgery is rarely considered for these patients. CONCLUSION: This report highlights the importance of considering surgery as an early treatment modality in selected cases.