‘Burned Out’ Hippocampus Syndrome: A Case Report Of Surgical Outcome Without Invasive Studies

Hippocampal sclerosis represents the most prevalent form of pharmacoresistant epilepsy encountered in clinical practice.Surgery has been demonstrated to be effective when the history of the disease, ictal semiology, interictal/ictal video EEG, neuropsychological and neuroimaging studies are concordant.However, challenges may arise when different modalities yield conflicting results regarding the lateralization of the epileptogenic zone.The pattern of unilateral hippocampal sclerosis on brain magnetic resonance imaging (MRI), with contralateral temporal scalp ictal onset in video EEG, coined as 'burned out' hippocampus syndrome may potentially complicate decision-making for surgical treatment especially when further invasive studies may not be possible in all medical centers dealing with epilepsy patients.We present a case report with this pattern and our approach and outcome of this rare occurrence in epilepsy surgery centers.