Distinct dual cortico-cortical networks successfully identified between supplemental and primary motor areas during intracranial EEG for drug-resistant frontal lobe epilepsy

Epilepsy & Behavior Reports

Takehiro Uda¹  Yasuhiro Matsuzaka²  Naohiro Yamamoto²  Shin Okazaki³  Toshiyuki Kawashima³  Yoko Nakanishi³  Shizuka Nagase³  Takeshi Inoue³  Megumi Nukui³  Hisashi Kawawaki⁴  Hiroshi Otsubo⁴  Noritsugu Kunihiro⁴  Ichiro Kuki⁴ 

[1] Corresponding author at: 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan.;Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan;Department of Pediatric Neurology, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan;Department of Pediatric Neurosurgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan;

关键词: Epilepsy surgery;    High-frequency oscillation;    Cortico-cortical evoked potential;    Supplementary motor area;    Primary motor area;   

DOI  :  

来源: DOAJ

【 摘 要 】

We present a case of drug-resistant focal motor seizures in which separate cortico-cortical epileptic networks within the supplementary motor area (SMA) proper and primary motor area (PMA) were proven by ictal high-frequency oscillation (HFO) and cortico-cortical evoked potential (CCEP). A 12-year-old girl presented with two types seizures: type A, tonic extension and subsequent clonic movements of the right arm; and type B, tonic and clonic movements of the right leg. MRI was normal and karyotype genetic analysis revealed 46,X,t(X;14)(q13;p12). She underwent placement of chronic subdural electrodes over the left hemisphere. We recorded a total of nine seizures during 10 days of epilepsy monitoring. Type A seizures started from the lower part of the left SMA proper and early spread to the hand motor area of the PMA. Type B seizures started from the upper part of the SMA proper and early spread to the leg motor area of the PMA. CCEPs of both SMA proper and PMA activated two identical routes for evoked potentials correlating with separate pathways. Corticectomy of the left SMA proper and PMA achieved seizure-free without hemiparesis. Within a small homunculus of the SMA proper, separate epileptic networks were proven and validated by seizure semiology, ictal HFO, and CCEP.

【 授权许可】

Unknown