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The predictive localizing value of tonic limb posturing in supplementary sensorimotor seizures
Y Aghakhani1, A Rosati, A Olivier
1Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada.
Objective:
To determine whether early tonic limb posturing is reliable in lateralizing or localizing of the seizure generator in 14 patients with pharmacoresistent supplementary sensorimotor area (SSMA) seizures.
Methods:
All patients underwent high-quality MRI scans and stereo-EEG recordings.
Results:
The SSMA seizure semiology predicted focal or regional ictal onset in the SSMA in six (43%) patients: Three had a focal SSMA seizure onset, and three had a regional seizure onset with involvement of one SSMA plus adjacent neocortex. The eight remaining patients had diffuse uni- or bilateral seizure onset. Eight of 14 patients underwent a frontal or central cortical resection, but a good outcome was seen in only 3: 2 with no SSMA resection and 1 with an extensive central removal.
Conclusions:
SSMA semiology is suggestive of early involvement of this region but is by no means a reliable indicator that the primary SSMA contains the seizure focus.