Epilepsia partialis continua triggered by traumatic hand injury: a peripheral tuning of brain excitability?

Epilepsia partialis continua is often refractory to antiepileptic medication and its causal relation to peripheral sensory stimuli has only rarely been suggested. We report a man who received surgery for temporal lobe epilepsy 10 years ago, who presented “de novo” epilepsia partialis continua follow...

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Bibliographic Details
Published in:Epileptic disorders 2016-03, Vol.18 (1), p.13-18
Main Authors: Paglioli, Eliseu, Alves Martins, William, De la Cruz, Walter, Andrade, Victor, Duval da Silva, Vinicius, Menezes Nunes, Rafael, Palmini, André
Format: Article
Language:English
Subjects:
Anticonvulsants - therapeutic use
Brain - physiopathology
disinhibition
Electroencephalography - methods
epilepsia partialis continua
Epilepsia Partialis Continua - diagnosis
Epilepsia Partialis Continua - drug therapy
Epilepsia Partialis Continua - etiology
Epilepsy
epilepsy surgery
focal cortical dysplasia
Hand Injuries - physiopathology
Humans
Male
Middle Aged
peripheral injury
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Summary:Epilepsia partialis continua is often refractory to antiepileptic medication and its causal relation to peripheral sensory stimuli has only rarely been suggested. We report a man who received surgery for temporal lobe epilepsy 10 years ago, who presented “de novo” epilepsia partialis continua following mild traumatic injury of the left hand. Continuous myoclonus of the left upper limb started the day after injury and persisted unabated for several weeks. Non‐invasive evaluation was inconclusive. Acute electrocorticography during surgery under local anaesthesia revealed continuous, rhythmic spiking over the right sensorimotor cortex. Tailored excision of the posterior bank of the motor and adjacent sensory cortex immediately stopped the continuous myoclonus. Histopathology showed abnormal radial lamination and was compatible with focal cortical dysplasia type IA. Epilepsia partialis continua did not recur for seven years. Afferent stimuli from peripheral injury can disinhibit hyperexcitable sensorimotor cortex leading to epilepsia partialis continua. [Published with video sequences online]
ISSN:1294-9361
1950-6945
DOI:10.1684/epd.2016.0798