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J Neurol Neurosurg Psychiatry 72:812-815 doi:10.1136/jnnp.72.6.812
  • Short report

Alteration of the cortical motor map in a patient with intractable focal seizures

  1. F A Lado,
  2. A D Legatt,
  3. P A LaSala,
  4. S Shinnar
  1. Comprehensive Epilepsy Management Center, Montefiore Medical Center, Bronx, New York, USA
  1. Correspondence to:
 Dr F A Lado, Department of Neurology, K313, Albert Einstein College of Medicine, 1410 Pelham Parkway South, Bronx, NY 10461, USA;
 ladof{at}ix.netcom.com
  • Received 21 October 2000
  • Accepted 15 January 2002
  • Revised 27 December 2001

Abstract

Patients with epilepsia partialis continua may develop progressive neurological deficits of unclear origin. It is possible that repetitive epileptic spikes induce plastic changes in the cortex analogous to the changes observed following direct microstimulation. A child is reported with focal cortical dysplasia, intractable focal seizures, worsening hemiparesis, and alteration of the cortical motor map over time. At age 7, he underwent cortical motor mapping before partial resection of a seizure focus within the right postcentral gyrus. No deficits were present after surgery, and seizure frequency declined by more than 90%. Seizures subsequently worsened and a progressive left hemiparesis developed. Cortical remapping at age 12 showed motor centres for left arm, face, and eye movements in an unusual configuration. The location of the motor representation of the face differed from the location obtained at age 7. This case provides direct electrophysiological evidence of reorganisation of the cortical motor map in the human brain.

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