Abstracts

Supplementary Motor Area (SMA) seizures are relatively common in children but there are small numbers reported in terms of surgical approach and outcome. Despite the fact that SMA epilepsy typically begins in childhood and is often refractory to AED treatment, surgical approaches to its management most often are delayed until adulthood. We report on the clinical features, evaluative test results (SPECT, invasive EEG) and surgical outcome in a series of 5 non-lesional children and adolescents, 3 of whom have had resective epilepsy surgery., Five children were characterized by means of seizure description, V-EEG, SISCOM, fMRI, and invasive intracranial recording with brain mapping, and seizures were localized to the SMA., Three of the five patients have had resective surgery, with mixed outcomes. None were initially seizure-free: one has had a few seizures due to non-compliance but otherwise has gone months at a time without seizures, one required a second resection in the primary motor cortex and is now seizure-free, and one has had a [gt]50% reduction in seizures. Of the non-operated patients, one declined surgery and one has been moderately well-controlled with AED therapy. All patients were non-lesional on MRI imaging; pathology showed cortical dysplasia in one and non-specific changes in the other two patients. The patient who required a second operation has a mild L hemiparesis, but had no deficits after the initial resection limited to the SMA, and the other two patients have no neurologic deficits., SMA seizures are not uncommon in children, with characteristic clinical features and seizure semiology like those described in adults. The seizures can be approached surgically with acceptable results and without deficits. Identification and characterization of SMA in children may allow for earlier successful surgical intervention, especially in cases involving focal cortical dysplasia as the underlying cause of the epilepsy. Use of adjunctive methods to localize, including SISCOM and invasive monitoring with stimulation and mapping, is essential for non-lesional cases. A common confounder appears to be the rapid propagation to the SMA from adjacent cortical areas (primary motor) or simultaneous onset, making surgery more challenging.,