Immediate improvement of motor function after epilepsy surgery in congenital hemiparesis
Tharick Pascoal1, Eliseu Paglioli, André Palmini
1Porto Alegre Epilepsy Surgery Program, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
Insights
Surgery for congenital hemiparesis unexpectedly improved hand function. Disconnecting motor pathways in the affected hemisphere resolved interference, enhancing control by the healthy hemisphere.
Area of Science:
- Neuroscience
- Neurosurgery
- Pediatric Neurology
Background:
- Congenital hemiparesis, often caused by stroke, frequently impairs hand function.
- Hemispherectomy can exacerbate hand motor deficits.
- Preserved hand function in some cases suggests alternative neural pathways.
Observation:
- A 17-year-old with congenital hemiparesis and intractable epilepsy underwent surgery.
- Intraoperative stimulation revealed preserved motor projections from the affected hemisphere to the paretic hand.
- A frontoparietal resection disconnected these projections.
Findings:
- The patient exhibited immediate and significant functional improvement in the paretic hand post-surgery.
- This contrasts with the expected loss or unchanged function after hemispherectomy.
- The disconnected crossed motor pathways were not beneficial and appeared dysfunctional.
Implications:
- Dysfunctional crossed motor pathways from the affected hemisphere can interfere with ipsilateral hand control by the contralesional hemisphere.
- Surgical disconnection of these aberrant pathways can restore motor function in congenital hemiparesis.
- This challenges the assumption that all crossed projections are compensatory and highlights potential therapeutic targets.
Abstract:
Hemispherectomy often leads to a loss of contralateral hand function. In some children with congenital hemiparesis, however, paretic hand function remains unchanged. An immediate improvement of hand function has never been reported. A 17-year-old boy with congenital hemiparesis and therapy-refractory seizures due to a large infarction in the territory of the middle cerebral artery underwent epilepsy surgery. Intraoperatively, electrical cortical stimulation of the affected hemisphere demonstrated preserved motor projections from the sensorimotor cortex to the (contralateral) paretic hand. A frontoparietal resection was performed, which included a complete disconnection of all motor projections originating in the sensorimotor cortex of the affected hemisphere. Surprisingly, the paretic hand showed a significant functional improvement immediately after the operation. This observation demonstrates that, in congenital hemiparesis, crossed motor projections from the affected hemisphere are not always beneficial, but can be dysfunctional, interfering with ipsilateral motor control over the paretic hand by the contralesional hemisphere.
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