Successful resection of a central focal cortical dysplasia (FCD) in a 6-months-old child with only very mild postoperative paresis [Erfolgreiche Resektion einer fokalen kortikalen Dysplasie (FCD) der Zentralregion bei einem 6 Monate alten Säugling mit nur sehr milder postoperativer Parese]
Dietel T.,Klinik und Ambulanz fur Kinder und Jugendliche |
Zentner J.,Albert Ludwigs University of Freiburg |
Ramantani G.,Universitats Kinderspital Zurich |
Schulze-Bonhage A.,Albert Ludwigs University of Freiburg |
And 6 more authors.
Zeitschrift fur Epileptologie | Year: 2016
Epilepsy surgery is an important treatment option in pharmaco-resistant epilepsies in newborns. However, many of the usually suitable diagnostic tools of presurgical diagnostics in order to estimate the individual risk of postoperative deficits cannot be applied in this age group. We report the case of an infant with epilepsy onset during the neonatal period due to a focal cortical dysplasia (FCD), which was localized by MRI at the age of 6 weeks in the left central region with involvement of the hand region in the precentral gyrus. Bilateral tonic seizures, myoclonic jerks with right preponderance and epileptic spasms occurred which were not improved by treatment with phenobarbital, vigabatrin, topiramate, levetiracetam oxcarbazepine and steroids (ACTH, prednisolone). Clinically only a mild right arm paresis was observed with independent movement abilities of the fingers and therefore almost no relevant impairment. At the age of six months the general development was retarded only very slightly. Presurgical diagnostics uncovered findings that justified epilepsy surgery. When informing the parents we pointed out that a complete loss of the hand function had to be expected. The extended left central lesionectomy was steered by neuronavigation and electrocorticography (ECoG) and was performed at the Neurozentrum Freiburg at the age of 6 months and with a body weight of 7 kg. Fortunately the child became completely seizure-free with a normalized EEG so that we could start to reduce the antiepileptic drugs after one year. Even during the immediately postoperative neurological rehabilitation a rapid improvement of the initially worsened arm and hand paresis became apparent. During the following course the preoperative functional state was achieved again. The girl was able to completely make up the retardation during the first postoperative year. This development was documented by means of neuropsychological assessments at 3, 6 and 12 months postoperatively. The almost unexpectedly positive postoperative course without relevant impairment of the motor hand function is not primarily explained by plasticity of the brain in infancy but by persistent ipsilateral motor tracts which usually degenerate prenatally. This case underlines the particular chances and the high importance of epilepsy surgery in infancy. © 2016 Springer-Verlag Berlin Heidelberg Source