Mirror movements following cortical resection of polymicrogyria in a child with intractable epilepsy
Rajesh RamachandranNair1, Hiroshi Otsubo, Ayako Ochi
1Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Abstract:
Mirror movements may be congenital or acquired. There are few reports of acquired mirror movements in pediatric patients. Further, mirror movements in children with epilepsy have rarely been reported. A 9-year old male, with intractable partial epilepsy resulting from polymicrogyria of the right hemisphere, underwent cortical resection of the right frontotemporoparietal region for a malformation of cortical development. He developed left hemiplegia and mirror movements in the left hand in the postoperative period. Four months after surgery, he remained seizure-free with mild residual left-sided hemiplegia and persistent mirror movements. Mechanisms postulated for mirror movements include aberrant pyramidal tract development and transcallosal inhibitory pathways. The latter mechanism might have contributed to the mirror movements observed in this child. This study is the first report of mirror movements following focal cortical resection for intractable epilepsy due to polymicrogyria.
Insights
This case study reports acquired mirror movements in a child after epilepsy surgery. It suggests transcallosal pathways may cause these movements in pediatric epilepsy patients.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Epileptology
Background:
- Mirror movements, involuntary symmetrical movements, can be congenital or acquired.
- Acquired mirror movements are rare in children, and even rarer in those with epilepsy.
- Focal cortical resection is a treatment for intractable epilepsy, but potential side effects require investigation.
Observation:
- A 9-year-old male with intractable partial epilepsy due to right hemisphere polymicrogyria underwent surgery.
- Postoperatively, the patient developed left hemiplegia and mirror movements in the left hand.
- Four months later, the patient was seizure-free but had persistent mirror movements and mild hemiplegia.
Findings:
- This is the first reported case of acquired mirror movements following focal cortical resection for intractable epilepsy caused by polymicrogyria.
- The findings suggest that aberrant transcallosal inhibitory pathways may contribute to mirror movements in this context.
- The study highlights a rare neurological complication in pediatric epilepsy surgery.
Implications:
- Understanding the mechanisms of acquired mirror movements is crucial for managing pediatric epilepsy patients.
- Further research into transcallosal pathways could inform surgical planning and postoperative care.
- This case underscores the importance of monitoring for rare neurological deficits after epilepsy surgery in children.
