Abstracts

Rationale: Congenital or early-acquired vascular destructive lesions often lead to medically refractory partial-onset seizures and epilepsy surgery is thus a common consideration. Because these are non-progressive insults, surgical strategies need to be tailored to remove the epileptogenic zone while preserving whatever function remains in the damaged hemisphere. When insult is prenatal or early post-natal, the degree of motor and language dysfunction depends upon the 'interaction' between extent of the lesion and mechanisms of brain plasticity that ultimately lead to some degree of recovery through reorganization of sensorimotor and language networks. We report seizure and motor outcome in 17 patients with vascular destructive lesions and focal resections to control seizures. Methods: We have performed presurgical evaluation, including fMRI, and partial resections in 17 patients with intractable epilepsy and congenital hemiparesis due to large cortico-subcortical vascular destructive lesions. They all had some preservation of contralateral arm/hand function and variable degrees of cortical infarct, loss of tissue in the region of the internal capsule and atrophy of the ipsilateral cerebral peduncle. Mean age of sz onset, epilepsy duration and follow up were 5.5 yrs [1-12], 13. 2 y [1-40] and 6.6 y [ 1-14], respectively. Motor outcome involved objective comparison of neurologic examination according to a predefined protocol before and after surgery and subjective impression of patient and relatives. Seizure outcome was classified according to Engel. Results: Seven patients (41%) improved motor function and all (100%) had complete or nearly complete seizure control. Seven others had unchanged function and 3 worsened. Of these latter 10 patients, only 4 (40%) had complete or nearly complete seizure control. Mean age at seizure onset of patients who improved motor function (3.1 years) was half of those who did not (6.2 years). Conclusions: Following localized resection of relevant epileptogenic tissue in patients with refractory seizures and congenital hemiparesis due to vascular destructive lesions, motor function of affected limbs may actually improve. Recurrent seizures may impact motor function and seizure control may be key to motor improvement.  Funding: None