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October 14, 2014; 83 (16) Article

“Mirror EPC”

Epilepsia partialis continua shifting sides after rolandic resection in dysplasia

Marta Hemb, Eliseu Paglioli, François Dubeau, Frederick Andermann, André Olivier, Jaderson C. da Costa, William A. Martins, Magda L. Nunes, André Palmini
First published September 12, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000878
Marta Hemb
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.
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Eliseu Paglioli
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.
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François Dubeau
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.
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Frederick Andermann
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.
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André Olivier
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.
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Jaderson C. da Costa
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.
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William A. Martins
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.
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Magda L. Nunes
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.
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André Palmini
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.
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Full PDF
Citation
“Mirror EPC”
Epilepsia partialis continua shifting sides after rolandic resection in dysplasia
Marta Hemb, Eliseu Paglioli, François Dubeau, Frederick Andermann, André Olivier, Jaderson C. da Costa, William A. Martins, Magda L. Nunes, André Palmini
Neurology Oct 2014, 83 (16) 1439-1443; DOI: 10.1212/WNL.0000000000000878

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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.

GLOSSARY

ECoG=
electrocorticography;
EPC=
epilepsia partialis continua;
FCD=
focal cortical dysplasia;
RE=
Rasmussen encephalitis

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received November 18, 2013.
  • Accepted in final form July 16, 2014.
  • © 2014 American Academy of Neurology
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