Epileptic Zone Resection for MRI-negative Refractory Epilepsy Originating from Primary Motor Cortex.

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Epileptic Zone Resection for MRI-negative Refractory Epilepsy Originating from Primary Motor Cortex.

World Neurosurg. 2017 Feb 26;:

Authors: Zhang G, Meng D, Liu Y, Yang K, Chen J, Su L, Zhang Z, Chen G

Abstract
OBJECTIVE: Because of the balance between achieving complete seizure freedom and minimizing the postoperative neurological deficits, surgery for refractory epilepsy originating from primary motor cortex is difficult. Here, we reported the outcomes of surgery for MRI-negative refractory epilepsy originating from primary motor cortex in a case series.
METHODS: Nine patients with refractory epilepsy originating from primary motor cortex underwent intracranial electrodes implantation after preoperative evaluation. Subdural grid electrodes and depth electrodes were implanted through craniotomy assisted by stereotactic technique. We delineated epileptic zone and executed tailored resection according to results of intracranial electroencephalography and mapping. The patients were followed up for at least one year. Muscle strength was respectively evaluated at different postoperative time (the first day, 2 weeks and 1 year).
RESULTS: With regard to seizure outcome at the last follow-up, Engel class I outcome was achieved in five patients, class II in three patients and class III in one patient. All cases had postoperative hemiparesis in different degree on the first day after operation. Three patients experienced distal muscle strength of single limb with grade 3 or lower and had obvious dysfunction at 1 year after operation. Six patients experienced distal muscle sterngth of grade 4 or 5(Medical Research Council six-point scale) and had no obvious dysfunction at that time.
CONCLUSIONS: Most patients of refractory epilepsy originating from primary motor cortex were seizure free and had no obvious neurological deficits in the follow-up. Epileptogenic zone resection may not be always contraindication for non-lesional refractory epilepsy patients originating from primary motor cortex.

PMID: 28249830 [PubMed - as supplied by publisher]

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