Periodic lateralized frontal epileptiform discharges with ipsilateral epilepsia partialis continua.
OBJECTIVE
Lateralized clonic jerks of the extremities during epileptic seizures usually arise from the contralateral rolandic cortex. In our exceptional case one-sided extremity twitches related to epileptiform activity in the ipsilateral frontal lobe.


METHODS
Case study with clinical-electroencephalographic correlation.


RESULTS
A 47-year-old man suffered destruction of most of his right cerebral hemisphere, including the perirolandic region. Epilepsia partialis continua (EPC) ensued, with clonic jerks of the proximal right upper and lower limbs temporally related to periodic lateralized epileptiform discharges (PLEDs) from the parasagittal region of the right frontal lobe with a variable time interval over 100 ms. Sectioning of the subcortical callosal and projection connections of the frontal lobe abolished the clonic jerks.


CONCLUSIONS
We propose the ipsilateral EPC arose from projections from the supplementary motor region to the medullary reticular formation to account for the long and variable latency between PLEDs and jerks.
Young
G Bryan
GB
Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada. bryan.young@lhsc.on.ca
Blume
Warren T
WT
D003337:Corpus Callosum / Q000503:physiopathology / Q000601:surgery; D004569:Electroencephalography / Q000706:statistics & numerical data; D017036:Epilepsia Partialis Continua / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D004830:Epilepsy, Tonic-Clonic / Q000503:physiopathology / Q000601:surgery; D005121:Extremities / Q000503:physiopathology*; D005625:Frontal Lobe / Q000503:physiopathology* / Q000601:surgery; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology / Q000601:surgery; D009434:Neural Pathways / Q000503:physiopathology / Q000601:surgery; D012154:Reticular Formation / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome