title: Bilateral symmetric tonic posturing suggesting propagation to the supplementary motor area in a patient with precuneate cortical dysplasia.
abstract: We report a patient manifesting seizures with bilateral symmetric tonic posturing, which were markedly reduced after resection of the left precuneus. A 16-year-old man had sudden onset, complex partial seizures with bilateral symmetric tonic posturing since the age of eight years. Magnetic resonance fluid-attenuated inversion-recovery imaging revealed a hyperintense lesion in left precuneus. In almost all focal seizures recorded during an invasive EEG evaluation, ictal onset was detected from the inferomesial aspect of the lesion, but fast paroxysmal discharges from the ipsilateral supplementary motor area (SMA) were observed just before the clinical onset. After surgical excision of the EEG onset zone, including the lesion, seizure frequency was markedly (> 95%) reduced. By the 20th month after surgery, there were only brief nocturnal seizures involving slight elevation of both shoulders and slight abduction of both arms, with preservation of consciousness occurring once every few days. Invasive EEG findings and surgical outcome suggested that the epileptic activity originating from the epileptogenic zone may have propagated to the symptomatogenic zone including mainly the ipsilateral SMA. In summary, we report an interesting case of bilateral symmetric tonic posturing suggesting propagation to the SMA. MRI and invasive EEG confirmed the epileptogenic focus as a precuneate cortical dysplasia lesion.[Published with video sequences].
authors: Department of Neurological Surgery, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan. umesh@szec.hosp.go.jp
authors: Shuichi
authors: S
authors: Umeoka
authors: Koichi
authors: K
authors: Baba
authors: Kiyohito
authors: K
authors: Terada
authors: Kazumi
authors: K
authors: Matsuda
authors: Takayasu
authors: T
authors: Tottori
authors: Naotaka
authors: N
authors: Usui
authors: Keiko
authors: K
authors: Usui
authors: Fumihiro
authors: F
authors: Nakamura
authors: Yushi
authors: Y
authors: Inoue
authors: Tateki
authors: T
authors: Fujiwara
authors: Tadahiro
authors: T
authors: Mihara
mesh_terms: D000293:Adolescent; D002540:Cerebral Cortex / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D003545:Cysteine / Q000031:analogs & derivatives; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000473:pathology / Q000503:physiopathology*; D019635:Neurosurgical Procedures; D015609:Organotechnetium Compounds; D010296:Parietal Lobe / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D011187:Posture / Q000502:physiology*; D019275:Radiopharmaceuticals; D012640:Seizures / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine