Medically intractable seizures originating from the primary somatosensory hand area.
A 33-year-old woman had begun having intractable somatosensory seizures affecting the left hand since the age of 13 years. Occasionally, her seizures progressed to left arm posturing followed by secondary generalization. Scalp EEG revealed interictal epileptiform discharges in the right posterior quadrant, but with no ictal EEG correlates. Brain MRI showed a right temporal encephalomalacia, sparing mesial temporal structures, suggestive of a perinatal vascular insult. Ictal electrocorticogram, electrical stimulation mapping, and somatosensory evoked potentials localized the ictal onset to the hand area of the postcentral gyrus. Resection of that area resulted in total resolution of seizures with no significant lasting deficits. Potential complications of resecting the primary somatosensory hand area can be severe, as proprioceptive sensory loss may be permanent, resulting in significant disability. Such deficits may be temporary however, and the literature continues to report conflicting results regarding postsurgical outcome. Cortical plasticity may explain recovery of sensory deficits after partial resection of the primary somatosensory hand area. Multiple subpial transections of that area are sometimes performed to minimize functional deficits, but seizure control may be less optimal than with cortical resection.
Koubeissi
Mohamad Z
MZ
Department of Neurology, Neurological Institute, University Hospitals Case Medical Center, Case School of Medicine, Cleveland, Ohio 44106-5040, USA. mohamad.koubeissi@uhhospitals.org
Maciunas
Robert J
RJ
Tanner
Adriana
A
Lüders
Hans O
HO
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001931:Brain Mapping; D004351:Drug Resistance; D004558:Electric Stimulation; D004569:Electroencephalography; D004678:Encephalomalacia / Q000473:pathology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006225:Hand / Q000294:innervation*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009434:Neural Pathways / Q000503:physiopathology; D009473:Neuronal Plasticity / Q000502:physiology; D011434:Proprioception / Q000502:physiology; D012640:Seizures / Q000188:drug therapy / Q000503:physiopathology*; D013003:Somatosensory Cortex / Q000503:physiopathology*
D000927:Anticonvulsants