title: Immediate improvement of motor function after epilepsy surgery in congenital hemiparesis.
abstract: Hemispherectomy often leads to a loss of contralateral hand function. In some children with congenital hemiparesis, however, paretic hand function remains unchanged. An immediate improvement of hand function has never been reported. A 17-year-old boy with congenital hemiparesis and therapy-refractory seizures due to a large infarction in the territory of the middle cerebral artery underwent epilepsy surgery. Intraoperatively, electrical cortical stimulation of the affected hemisphere demonstrated preserved motor projections from the sensorimotor cortex to the (contralateral) paretic hand. A frontoparietal resection was performed, which included a complete disconnection of all motor projections originating in the sensorimotor cortex of the affected hemisphere. Surprisingly, the paretic hand showed a significant functional improvement immediately after the operation. This observation demonstrates that, in congenital hemiparesis, crossed motor projections from the affected hemisphere are not always beneficial, but can be dysfunctional, interfering with ipsilateral motor control over the paretic hand by the contralesional hemisphere.
authors.affiliation: Porto Alegre Epilepsy Surgery Program, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Tharick
authors.initials: T
authors.lastname: Pascoal
authors.forename: Eliseu
authors.initials: E
authors.lastname: Paglioli
authors.forename: André
authors.initials: A
authors.lastname: Palmini
authors.forename: Rafael
authors.initials: R
authors.lastname: Menezes
authors.forename: Martin
authors.initials: M
authors.lastname: Staudt
mesh_terms: D000293:Adolescent; D001921:Brain / Q000098:blood supply / Q000473:pathology; D004827:Epilepsy / Q000601:surgery*; D038421:Hemispherectomy / Q000592:standards*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D010100:Oxygen / Q000097:blood; D010291:Paresis / Q000150:complications* / Q000151:congenital*
chemical_list: D010100:Oxygen
keywords: Congenital hemiparesis; Corticospinal tract; Epilepsy surgery; Sensorimotor reorganization; fMRI