John Libbey Eurotext

MRI-negative frontal lobe epilepsy with ipsilateral akinesia and reflex activation Volume 10, issue 4, December 2008


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Brain Institute and Comprehensive Epilepsy Program, Miami Children’s Hospital, Department of Neurology, University of Miami Miller School of Medicine, Department of Neurosurgery, University of Miami Miller School of Medicine, Miami Florida, USA

[Case records of Epileptic Disorders. Anatomo-electro-clinical correlations. Case 04-2008] The pre-operative assessment and surgical management of children and young adults with MRI-negative, frontal lobe epilepsy is often challenging owing to the semiologic expression being unusual or non-lateralizing. Localization based on functional tests may be non-convergent, further compounding the difficulty of surgical planning. We describe a patient with seizures presenting with early, subjective akinesia of the dominant hand that were at times triggered by repetitive motor tasks. Subdural EEG monitoring revealed seizure-origin in the ipsilateral dorsolateral frontal lobe. After resective surgery the patient has had a seizure free period of 9 months, and is free of deficits. This is the first report of frontal lobe seizure semiology consisting of ipsilateral ictal akinesia. [Published with video sequences]