MRI-negative frontal lobe epilepsy with ipsilateral akinesia and reflex activation.
The pre-operative assessment and surgical management of children and young adults with MRI-negative, frontal lobe epilepsy is often challenging owing to the semiologic expression being unusual or non-lateralizing. Localization based on functional tests may be non-convergent, further compounding the difficulty of surgical planning. We describe a patient with seizures presenting with early, subjective akinesia of the dominant hand that were at times triggered by repetitive motor tasks. Subdural EEG monitoring revealed seizure-origin in the ipsilateral dorsolateral frontal lobe. After resective surgery the patient has had a seizure free period of 9 months, and is free of deficits. This is the first report of frontal lobe seizure semiology consisting of ipsilateral ictal akinesia.
Malone
Stephen
S
Brain Institute and Comprehensive Epilepsy Program, Miami Children's Hospital, FL, USA.
Miller
Ian
I
Jakayar
Prasanna
P
Resnick
Trevor
T
Bhatia
Sanjiv
S
Duchowny
Michael
M
D000293:Adolescent; D020820:Dyskinesias / Q000209:etiology*; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D007839:Functional Laterality / Q000502:physiology; D006225:Hand / Q000294:innervation / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009068:Movement / Q000502:physiology; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D012018:Reflex / Q000502:physiology*; D012640:Seizures / Q000209:etiology / Q000503:physiopathology