Abstracts

Supplementary motor seizure semiology is most commonly associated with symptomatogenic involvement in the supplementary sensori-motor area (SSMA) and adjacent cortical areas, but patients with epileptogenic area itself arising exclusively from the SSMA (i.e. SSMA epilepsy) are uncommon. Only a minority of patients with SSMA epilepsy has been reported to remain seizure free after surgery. We evaluated clinical, noninvasive and invasive EEG findings and surgical outcome for 6 adult patients with intractable SSMA epilepsy.
We evaluated 6 adult patients with intractable SSMA epilepsy. All patients had preoperative brain MRI, Wada test, neuropsychological test, noninvasive video-EEG monitoring, interictal and ictal brain SPECT. Invasive video-EEG monitorings using subdural grid(s) and strips were performed in all patients.
In 6 patients, MRI findings were normal in 4 and focal abnormalities on the SSMA in 2. We recorded ictal SSMA semiology in all patients. Interictal and ictal SPECT were correctly lateralized in 1. Noninvasive and invasive EEG recordings showed interictal and ictal discharges on the right SSMA in 4 and the left SSMA in 2. We resected right SSMA in 4 and left SSMA in 2. Surgical outcome (follow-up period: 47 [plusmn] 15.8 months) was Engel[apos]s classification Class I in 5 and Class II in 1. Long-term neurological follow-up revealed no postoperative neurological deficits in all patients. Histopathologic findings demonstrated cortical dysplasia in 5 and unremarkable in 1.
Resection of SSMA in SSMA epilepsy has excellent surgical outcome in long-term follow-up, regardless of normal or abnormal MRI.