Dados do Trabalho

Título

Clinical evolution following localized resections of the primary sensory cortex for refractory seizures: the issue of eloquent versus indispensable cortical regions

Apresentação do caso

Five adults (3 men) were evaluated for a month to 8 years after S1 resection surgery. Imaging and prolonged EEG recordings showed that 3 had type II focal cortical dysplasia (FCD) localized to S1 and 2 had congenital gliotic lesions, with extension of the epileptogenic tissue to S1. Before operation, all five reported sensory auras in the beginning of their seizures, followed by motor symptoms or disconnection. After resection of S1, 4 are seizure free and one still has seizures without a sensory aura. At discharge following surgery, all had related neurological symptoms and signs, including proprioceptive deficits such as disturbance of fine movements with the affected hand and difficulties to walk because of insecurity with positioning the affected lower limb (5/5), tactile (4 / 5) or tactile and thermalgesic hypoesthesia (1/5). One complained of painful leg and foot dysesthesia. Deficits persisted to a significant degree for 1 month to 2 years, but mostly resolved after 6 months. At the last contact, the 4 patients operated for more than 6 months had recovered full function of the right hemibody, with subjective improvements between 70 and 90 %, 3 of whom had intensive neuro-rehabilitation therapies.

Discussão

Resection of S1 is expected to lead to sensory abnormalities. The rate and extent of recovery, however, suggest that S1 should be considered an eloquent, but not an indispensable cortical region. This is important, as epileptogenic zones may involve S1 and resective epilepsy surgery has a potential curative impact, transforming the lives of people with refractory seizures. This report was focused on sensory complaints, particularly paresthesia, dysesthesia and proprioceptive deficits. Whether patients followed a neurorehabilitation program was also noted.

Comentários finais

Epileptogenic zones often affect eloquent cortex in patients with drug refractory seizures, raising the issue of whether or not curative surgery would be advisable considering possible sequelae. The primary sensory cortex (S1) is considered an eloquent cortical region, yet despite being a fairly common site of epileptogenic lesions, the type and evolution of deficits following localized resections of S1 are not clearly documented.