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Neurological picture
I cannot stand this anymore!
  1. Anteneh M Feyissa1,
  2. Jeffrey W Britton1,
  3. Jamie J Van Gompel2,
  4. S Matt Stead1
  1. 1Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Departments of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Anteneh M Feyissa, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Feyissa.Anteneh{at}mayo.edu

http://dx.doi.org/10.1136/jnnp-2014-309944

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    Chronic cortical stimulation for intractable focal reflex epilepsy

    A 28-year-old right-handed man presented with medically intractable focal reflex epilepsy. He previously underwent resection of a right parietal lobe cortical dysplasia. Postoperatively, he developed focal reflex epilepsy triggered by motor activation of the left lower extremity. These were refractory to multiple antiepileptic drugs (AEDs) and vagal nerve stimulation therapy (VNS), and prevented standing and walking. Clinical examination showed mild left hemiparesis and left lower extremity myoclonic seizures triggered by motor activation and standing (see online supplementary video 1). Scalp EEG showed focal seizure discharges consisting of rhythmic midline central sharp waves. Brain MRI showed postoperative signal hyperintensity in the region of the prior resection (figure 1A). Subtraction ictal single-photon emission CT coregistered to MRI (SISCOM) demonstrated ictal hyperperfusion in the near prior resection cavity in leg motor area (figure 1B).

    Figure 1

    (A) …

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    Footnotes

    • Contributors All authors made substantial contribution to the patient's clinical care and data collections. AMF, JWB, JJVG and SMS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis. SMS was involved in study concept and design. AMF, SMS, JJVG and JWB were involved in acquisition of data. AMF and JWB were involved in drafting of the manuscript. AMF, JJVG, JWB and SMS were involved in critical revision of the manuscript for important intellectual content.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.