title: Persistent verbal and behavioral deficits after resection of the left supplementary motor area in epilepsy surgery.
abstract: An 8-year-old boy underwent a resection for focal cortical dysplasia at the left supplementary motor area (SMA) for the treatment of intractable epilepsy. The manifestations of SMA syndrome, such as transient mutism and right hemiparesis, resolved within a few weeks. Verbal disfluency and impaired executive function, accompanied by impulsivity and distractibility, persisted for more than 12months. The verbal and behavioral problems caused serious difficulties in the school life of the patient, until they became less evident at 18months after surgery. Tractography performed 18months after surgery revealed a defect in the subportion of fronto-parietal association fibers within the left superior longitudinal fascicles. Verbal influency can persist with unusually long duration after resection of SMA during childhood. Although not discernible on the routine neuroimaging, white matter damage beneath the SMA region could result in serious disabilities in executive function. These complications should be recognized for the prediction and assessment of deficits in children after surgical intervention involving this region.
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Endo
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan. Electronic address: saitoyo@ncnp.go.jp.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Department of Neurosurgery, National Center of Neurology and Psychiatry, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Otsuki
authors.affiliation: Department of Neurosurgery, National Center of Neurology and Psychiatry, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Department of Radiology, National Center of Neurology and Psychiatry, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakata
authors.affiliation: Department of Clinical Psychology, National Center of Neurology and Psychiatry, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Okada
authors.affiliation: Department of Rehabilitation, National Center of Neurology and Psychiatry, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Hirozane
authors.affiliation: Department of Neurosurgery, National Center of Neurology and Psychiatry, Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Kaido
authors.affiliation: Department of Neurosurgery, National Center of Neurology and Psychiatry, Japan.
authors.forename: Yuu
authors.initials: Y
authors.lastname: Kaneko
authors.affiliation: Department of Pediatrics, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 350-8550, Japan.
authors.forename: Eiko
authors.initials: E
authors.lastname: Takada
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Okazaki
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Enokizno
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Komaki
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Nakagawa
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugai
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigachi-cho, Kodaira, Tokyo 187-8551, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sasaki
mesh_terms: D002648:Child; D006801:Humans; D007806:Language Disorders / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000601:surgery*; D001523:Mental Disorders / Q000209:etiology*; D009044:Motor Cortex / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000503:physiopathology*; D014705:Verbal Behavior / Q000502:physiology
keywords: Attention deficit hyperactivity disorder; Fluency; Superior longitudinal fasciculus; Supplementary motor area; Transcortical motor aphasia