Marta Hemb1, Eliseu Paglioli2, François Dubeau2, Frederick Andermann2, André Olivier2, Jaderson C da Costa2, William A Martins2, Magda L Nunes2, André Palmini2. 1. From the Service of Neurology (M.H., J.C.d.C., W.A.M., M.L.N., A.P.), Service of Neurosurgery (E.P.), Porto Alegre Epilepsy Surgery Program (M.H., E.P., J.C.d.C., A.P.), Department of Internal Medicine, Division of Neurology (J.C.d.C., M.L.N., A.P.), Department of Surgery (E.P.), The Brain Institute (InsCer) (J.C.d.C., M.L.N.), Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; and Montreal Neurological Institute (F.D., F.A., A.O.), Department of Neurology and Neurosurgery, McGill University, Montreal, Canada. martahemb@hotmail.com. 2. From the Service of Neurology (M.H., J.C.d.C., W.A.M., M.L.N., A.P.), Service of Neurosurgery (E.P.), Porto Alegre Epilepsy Surgery Program (M.H., E.P., J.C.d.C., A.P.), Department of Internal Medicine, Division of Neurology (J.C.d.C., M.L.N., A.P.), Department of Surgery (E.P.), The Brain Institute (InsCer) (J.C.d.C., M.L.N.), Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; and Montreal Neurological Institute (F.D., F.A., A.O.), Department of Neurology and Neurosurgery, McGill University, Montreal, Canada.
Abstract
BACKGROUND: Epilepsia partialis continua (EPC) is a life-threatening condition often caused by focal cortical dysplasia (FCD). Resection of the motor cortex is contemplated in the hope that the trade-off between a severe motor deficit and complete seizure control justifies the procedure. METHODS: Report of 3 patients with EPC due to histologically confirmed FCD, who underwent resection of the motor cortex under acute electrocorticography. RESULTS: All had re-emergence of medically intractable EPC in the other side of the body after rolandic resection. Two patients died and the third continues with refractory attacks. CONCLUSION: In some instances, EPC due to FCD may shift sides and re-emerge in the contralateral, previously asymptomatic, hemibody. A mechanism of disinhibition by surgery of a suppressed contralateral and homologous epileptogenic zone is speculated.
BACKGROUND:Epilepsia partialis continua (EPC) is a life-threatening condition often caused by focal cortical dysplasia (FCD). Resection of the motor cortex is contemplated in the hope that the trade-off between a severe motor deficit and complete seizure control justifies the procedure. METHODS: Report of 3 patients with EPC due to histologically confirmed FCD, who underwent resection of the motor cortex under acute electrocorticography. RESULTS: All had re-emergence of medically intractable EPC in the other side of the body after rolandic resection. Two patients died and the third continues with refractory attacks. CONCLUSION: In some instances, EPC due to FCD may shift sides and re-emerge in the contralateral, previously asymptomatic, hemibody. A mechanism of disinhibition by surgery of a suppressed contralateral and homologous epileptogenic zone is speculated.
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