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We will demonstrate that FIRDA (frontal intermittent rhythmic delta activity) - otherwise related to systemic disorders and encephalopathy - has a role as an epileptic biomarker of deep seated midline SOZ. Its abolishment following SEEG guided radiofrequency of such SOZ correlates with clinical improvement, suggests its role as a non-invasive biomarker of otherwise inaccessible SOZs.We report the case of AK who was admitted with "psychiatric and gastrointestinal complaints". AK's complaints were further associated with FIRDA during VEEG. His previous refractoriness to AEDs, the clinico-electroencephalographic correlation, MRI showing bilateral hippocampal atrophy (more to the left) and severe memory deficits prompted us to suggest a left temporo-mesial SOZ, for which SEEG was done. Dual SEEG and scalp electrodes was used primarily for diagnostic purpose but taking into account an option for a therapeutic action by RF ablation.The dual array demonstrated a clear association between left hippocampal high voltage spikes and HFO's on SEEG recordings with FIRDA on concomitant scalp EEG parallel to behavioral changes, as suspected on our preliminary hypothesis. A further RF ablation eliminated the epileptiform activity (Spikes, HFO's and FIRDA) followed by clinical improvement.This is the first report showing the clinical significance of FIRDA associated with behavioral changes as a marker for latent refractory mesial epilepsy. SEEG exploration has the potential to uncover deep sources which are manifested as FIRDA on scalp EEG. These abnormalities and clinical symptoms can be eliminated by RF ablation.

About one percent (over 81,000 patients) of the Israeli population suffer from epilepsy. The main treatment for this condition is medication, but about a third of the patients suffer from drug-resistant epilepsy (DRE). Each year about 5,000 new patients are diagnosed with epilepsy, of whom 3,000 are children. For these patients, an evaluation in designated centers is required in order to diagnose possible foci and propose neurosurgical treatment alternatives.A model for diagnosis and treatment of the epileptic network in a minimally invasive approach is presented through the description of a case study. Phase I: includes diagnosis of the semiology, neuropsychological assessment, video EEG recording and performing a PET-MRI-FMRI-EEG synchronized examination. Phase II: involves stereo-electroencephalography (SEEG) minimally invasive diagnosis to target the epileptic area and accurately map adjacent functional areas and assessment of cortical redundancy. Phase III: includes radiofrequency ablation of the foci without any further surgery. This procedure is performed under clinical monitoring (the patient is awake during treatment) and continuous EEG monitoring.This case study demonstrates the multi-dimensional model performed by a multidisciplinary team, combining innovative technologies. This model is essential for the precision of the diagnosis and treatment methods of focal epilepsy and allows preservation of function based, among other factors, on the identification of cortical redundancy.The preoperative assessment identified focal epilepsy adjacent to the motor area dominating the right hand. A combined PET-FMRI-MRI-EEG examination enabled detecting redundancy of motor functions beyond the epileptic focus. Based on this information, a targeted implantation of depth electrodes (SEEG) was performed, the epileptic foci were identified and targeted ablations were performed during clinical monitoring and continuous EEG. This resulted in the cessation of seizures in parallel with the disappearance of the pathological signal in the EEG, all while preserving the patient's hand function.