title: Surgical resection of an epileptogenic cortical dysplasia in the deep foot sensorimotor area.
abstract: Epileptogenic foci in the foot/leg motor area of cortex are rarely resected, due to the risks of the surgical procedures. A 31-year-old right-handed man with cortical dysplasia deep in the central sulcus suffered from disturbances in walking due to frequent daily seizures. Following subdural electrode implantation to define the epileptogenic area and assess cortical function, limited regions of cortex were removed from the foot/leg primary motor and sensory areas under local anesthesia until the epileptiform discharges disappeared. Postoperative motor weakness and sensory disturbances completely resolved within 2 weeks and 2 months, respectively; the patient has been free from seizures for more than a year and a half postsurgery. Intraoperative examination demonstrated that small and moderate cortical dysplasia in the depths of the central sulcus exhibits both intrinsic epileptogenicity and function. Focused resection of the lower extremity of the sensorimotor area may be a surgical strategy for intractable epilepsy if resolution of clinical symptoms with minimal dysfunction due to the limited size of the resection is expected to follow surgery.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. mikunin@kuhp.kyoto-u.ac.jp
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Mikuni
authors.forename: Akio
authors.initials: A
authors.lastname: Ikeda
authors.forename: Hayase
authors.initials: H
authors.lastname: Yoneko
authors.forename: Shigeru
authors.initials: S
authors.lastname: Amano
authors.forename: Takashi
authors.initials: T
authors.lastname: Hanakawa
authors.forename: Hidenao
authors.initials: H
authors.lastname: Fukuyama
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005528:Foot / Q000294:innervation*; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000473:pathology / Q000601:surgery*; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology; D009434:Neural Pathways; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000503:physiopathology / Q000523:psychology; D012640:Seizures / Q000209:etiology; D013003:Somatosensory Cortex / Q000473:pathology / Q000601:surgery*