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Immediate improvement of motor function after epilepsy surgery in congenital hemiparesis
Author(s) -
Pascoal Tharick,
Paglioli Eliseu,
Palmini André,
Menezes Rafael,
Staudt Martin
Publication year - 2013
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.12244
Subject(s) - hemispherectomy , hemiparesis , epilepsy , medicine , motor cortex , psychology , epilepsy surgery , physical medicine and rehabilitation , neuroscience , surgery , stimulation , lesion
Summary Hemispherectomy often leads to a loss of contralateral hand function. In some children with congenital hemiparesis, however, paretic hand function remains unchanged. An immediate improvement of hand function has never been reported. A 17‐year‐old boy with congenital hemiparesis and therapy‐refractory seizures due to a large infarction in the territory of the middle cerebral artery underwent epilepsy surgery. Intraoperatively, electrical cortical stimulation of the affected hemisphere demonstrated preserved motor projections from the sensorimotor cortex to the (contralateral) paretic hand. A frontoparietal resection was performed, which included a complete disconnection of all motor projections originating in the sensorimotor cortex of the affected hemisphere. Surprisingly, the paretic hand showed a significant functional improvement immediately after the operation. This observation demonstrates that, in congenital hemiparesis, crossed motor projections from the affected hemisphere are not always beneficial, but can be dysfunctional, interfering with ipsilateral motor control over the paretic hand by the contralesional hemisphere.