title: Epilepsia partialis continua triggered by traumatic hand injury: a peripheral tuning of brain excitability?
abstract: Epilepsia partialis continua is often refractory to antiepileptic medication and its causal relation to peripheral sensory stimuli has only rarely been suggested. We report a man who received surgery for temporal lobe epilepsy 10 years ago, who presented "de novo" epilepsia partialis continua following mild traumatic injury of the left hand. Continuous myoclonus of the left upper limb started the day after injury and persisted unabated for several weeks. Non-invasive evaluation was inconclusive. Acute electrocorticography during surgery under local anaesthesia revealed continuous, rhythmic spiking over the right sensorimotor cortex. Tailored excision of the posterior bank of the motor and adjacent sensory cortex immediately stopped the continuous myoclonus. Histopathology showed abnormal radial lamination and was compatible with focal cortical dysplasia type IA. Epilepsia partialis continua did not recur for seven years. Afferent stimuli from peripheral injury can disinhibit hyperexcitable sensorimotor cortex leading to epilepsia partialis continua. [Published with video sequences online].
authors.affiliation: Service of Neurosurgery, Hospital São Lucas, Porto Alegre, Department of Surgery, Faculty of Medicine, Porto Alegre, Porto Alegre Epilepsy Surgery Program, Hospital São Lucas.
authors.forename: Eliseu
authors.initials: E
authors.lastname: Paglioli
authors.affiliation: Porto Alegre Epilepsy Surgery Program, Hospital São Lucas, Service of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre.
authors.forename: William Alves
authors.initials: WA
authors.lastname: Martins
authors.affiliation: Departament of Epilepsy, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
authors.forename: Walter De la
authors.initials: Wde L
authors.lastname: Cruz
authors.affiliation: Porto Alegre Epilepsy Surgery Program, Hospital São Lucas, Service of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre.
authors.forename: Victor
authors.initials: V
authors.lastname: Andrade
authors.affiliation: Department of Pathology, Hospital São Lucas, Pontifícia Universidade Católica do Rio, Grande do Sul (PUCRS), Porto Alegre.
authors.forename: Vinicius Duval da
authors.initials: VD
authors.lastname: Silva
authors.affiliation: Porto Alegre Epilepsy Surgery Program, Hospital São Lucas.
authors.forename: Rafael Menezes
authors.initials: RM
authors.lastname: Nunes
authors.affiliation: Porto Alegre Epilepsy Surgery Program, Hospital São Lucas, Service of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Internal Medicine, Division of Neurology, Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Palmini
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology*; D004569:Electroencephalography / Q000379:methods; D017036:Epilepsia Partialis Continua / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006230:Hand Injuries / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000927:Anticonvulsants
keywords: disinhibition; epilepsia partialis continua; epilepsy surgery; focal cortical dysplasia; peripheral injury