Author Response: Benefits and Risks of Epilepsy Surgery in Patients With Focal Cortical Dysplasia Type 2 in the Central Region
FrancineChassoux, neurologist, Sainte-Anne Hospital Paris France
Submitted August 17, 2022
We are grateful for the opportunity to respond to the comments by Dr. Abe on our research.1 As described in the results section of the article, 11 patients had a preoperative deficit which was either permanent (including a spastic component in 2 and arm atrophy in 1) or fluctuating, according to the seizure frequency (clumsiness or hemineglect). Postoperatively, all of them had a transitory worsening (which was major in 5 patients), then a recovery including functional improvement in 4. Among the 49 patients with normal preoperative examination, 41 had a postoperative deficit (which was major in 14).
Whatever the preoperative status, major deficits only occurred after resections of the primary motor cortex (PMC) or supplementary motor area (SMA). PMC resections were followed by pure motor deficits involving a limb or a part of limb with a central topography. Resections performed near the hand knob induced a brachial deficit predominant on the hand, but without selective involvement of fingers. SMA resections were followed by massive hemiplegia with proximal predominance and speech disturbances. A total or subtotal recovery occurred in most patients. Minor to moderate deficits included mild hand clumsiness, slow finger tapping, or a limitation for carrying heavy loads. Permanent major deficits occurred in 3 patients, who presented with central characteristics including spasticity. Contrasting with the observations based on small cortical infarctions, none of the postoperative motor deficits mimicked a peripheral nerve palsy.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Chassoux F, Mellerio C, Laurent A, Landre E, Turak B, Devaux B. Benefits and Risks of Epilepsy Surgery in Patients With Focal Cortical Dysplasia Type 2 in the Central Region. Neurology. 2022;99(1):e11-e22. doi:10.1212/WNL.0000000000200345
We are grateful for the opportunity to respond to the comments by Dr. Abe on our research.1 As described in the results section of the article, 11 patients had a preoperative deficit which was either permanent (including a spastic component in 2 and arm atrophy in 1) or fluctuating, according to the seizure frequency (clumsiness or hemineglect). Postoperatively, all of them had a transitory worsening (which was major in 5 patients), then a recovery including functional improvement in 4. Among the 49 patients with normal preoperative examination, 41 had a postoperative deficit (which was major in 14).
Whatever the preoperative status, major deficits only occurred after resections of the primary motor cortex (PMC) or supplementary motor area (SMA). PMC resections were followed by pure motor deficits involving a limb or a part of limb with a central topography. Resections performed near the hand knob induced a brachial deficit predominant on the hand, but without selective involvement of fingers. SMA resections were followed by massive hemiplegia with proximal predominance and speech disturbances. A total or subtotal recovery occurred in most patients. Minor to moderate deficits included mild hand clumsiness, slow finger tapping, or a limitation for carrying heavy loads. Permanent major deficits occurred in 3 patients, who presented with central characteristics including spasticity. Contrasting with the observations based on small cortical infarctions, none of the postoperative motor deficits mimicked a peripheral nerve palsy.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References