Surgical Strategies in Patients with the Supplementary Sensorimotor Area Seizure

  • Oh, Young-Min (Division of Neurosurgery, Research Institute for Clinical Medicine, Chonbuk National University Medical School/Hospital) ;
  • Koh, Eun-Jeong (Division of Neurosurgery, Research Institute for Clinical Medicine, Chonbuk National University Medical School/Hospital) ;
  • Lee, Woo-Jong (Division of Neurosurgery, Research Institute for Clinical Medicine, Chonbuk National University Medical School/Hospital) ;
  • Han, Jeong-Hoon (Division of Neurosurgery, Research Institute for Clinical Medicine, Chonbuk National University Medical School/Hospital) ;
  • Choi, Ha-Young (Division of Neurosurgery, Research Institute for Clinical Medicine, Chonbuk National University Medical School/Hospital)
  • Published : 2006.11.30

Abstract

Objective : This study was designed to analyze surgical strategies for patients with intractable supplementary sensorimotor area[SSMA] seizures. Methods : Seventeen patients who had surgical treatment were reviewed retrospectively. Preoperatively, phase I [non-invasive] and phase II [invasive] evaluation methods for epilepsy surgery were done. Seizure outcome was assessed with Engel's classification. The mean follow-up period was 27.2 months [from 12 months to 54 months]. Results : An MRI identified structural abnormality in eight patients and 3D-surface rendering revealed abnormal gyration in three. PET, SPECT, and surface EEG could not delineate the epileptogenic zone. Video-EEG monitoring with a subdural grid or depth electrodes verified the epileptogenic zone in all patients. Surgical procedures consisted of a resection of the SSMA and simultaneous callosotomy in two patients, a resection of the SSMA extending to the adjacent area in seven, a resection of a different area without a SSMA resection in seven, and a callosotomy in one. Seizure outcomes were class I in 11 [65%]. class II in five [29%], class III in one [6%]. Conclusion : In patients with intractable SSMA seizure, surgery was an excellent treatment modality. Precise delineation of the epileptogenic zone based on multimodal diagnostic methods can provide good surgical outcomes without neurological complications.

Keywords

References

  1. Bleasel A, Comair Y, Luders HO : Surgical ablations of the mesial frontal lobe in humans. Adv Neurol 70 : 217-235, 1996
  2. Blume WT, Oliver LM : Noninvasive electroencephalography in supplementary sensorimotor area epilepsy. Adv Neurol 70 : 309-337, 1996
  3. Chauvel PY, Rey M, Buser P, Bancaud J : What stimulation of the Supplementary Motor area in Humans Tells about its Functional Organization. Adv Neurol 70 : 199-209, 1996
  4. Chung TG, Lee JK, Kang JG, Lee SA, Ko TS, Khang SK, et al : Surgical result of the supplementary sensorimotor area seizure. J Korean Neurosurg Soc 31 : 411-418, 2002
  5. Duchowny M, Paolicchi JM, Jayakar P, Pesnick T, Alvarez L, Morrison G, et al : Prognostic significance of presurgical variables on outcome of focal resections in preadolescent children with intractable partial epilepsy. Epilepsia (Suppl 6) 39 : 66, 1998
  6. Fish DR : Magnetic resornance imaging and supplementary motor area epilepsy. Adv Neurol 70 : 341-351, 1996
  7. Ikeda A, Sato T, Ohara S, Matsuhashi M, Yamamoto J, Takayama M, et al : Supplementary motor area(SMA) seizure rather than SMA epilepsy in optimal surgical candidates : a document of subdural mapping. J Neurol Sci 202 : 43-52, 2002 https://doi.org/10.1016/S0022-510X(02)00199-5
  8. Kim CH, Chung CK, Lee SK, Lee YK, Chi J : Parietal lobe epilepsy : surgical treatment and outcome. J Korean Neurosurg Soc 36 : 93-101, 2004
  9. Laplane D, Degos J : Motor neglect. J Neurol Neurosurg Psychiat 46 : 152-158, 1983 https://doi.org/10.1136/jnnp.46.2.152
  10. Laplane D, Talairach J, Meininger V, Bancaud J, Orgogozo J : Clinical consequences of corticectomies involving the supplementary motor area in man. J Neurol Sci 34 : 301-314, 1977 https://doi.org/10.1016/0022-510X(77)90148-4
  11. Lee SK, Lee SY, Kim KK, Hong KS, Lee DS, Chung CK : Surgical outcome and prognostic factors of cryptogenic neocortical epilepsy. Ann Neurol 58 : 525-532, 2005 https://doi.org/10.1002/ana.20569
  12. Lim SH, Dinner DS, Pillay PK, Luders HO, Morris HH, Klem G, et al : Functional anatomy of the human supplementary sensorimotor area : results of extraoperative electrical stimulation. Electroencephalogr Clin Neurophysiol 91 : 179-193, 1994 https://doi.org/10.1016/0013-4694(94)90068-X
  13. Luders HO : The Supplementary sensorimotor area, An Overview. Adv Neurol 70 : 1-16, 1996
  14. Manford M, Fish DR, Shorvon SD : An analysis of clinical seizure patterns and their localizing value in frontal and temporal lobe epilepsies. Brain 119 : 17-40, 1996 https://doi.org/10.1093/brain/119.1.17
  15. Morris HH, Dinner DS, Luders HO, Wyllie E, Kramer R : Supplementary motor seizures : clinical and electroencephalographic findings. Neurology 38 : 1075-1082, 1988 https://doi.org/10.1212/WNL.38.7.1075
  16. Ohara S, Ikeda A, Kunieda T, Yazawa S, Taki J, Nagamine T, et al : Propagation of tonic posturing in supplementary motor area(SMA) seizures. Epilepsy Research 62 : 179-187, 2004 https://doi.org/10.1016/j.eplepsyres.2004.09.002
  17. Penfield W, Welch K : The supplementary motor area of the cerebral cortex. Arch Neurol Psychiat 66 : 289-317, 1951 https://doi.org/10.1001/archneurpsyc.1951.02320090038004
  18. Van Ness C : Invasive electroencephalography in the evaluation of supplementary motor area seizures. Adv Neurol 70 : 319-340, 1996
  19. Zentner J, Hufnagel A, Pechstein U, Wolf HK, Schramm J : Functional results after resective procedures involving the supplementary motor area. J Neurosurg 85 : 542-549, 1996 https://doi.org/10.3171/jns.1996.85.4.0542