Surgical Strategies in Patients with the Supplementary Sensorimotor Area Seizure

Oh, Young Min; Koh, Eun Jeong; Lee, Woo Jong; Han, Jeong Hoon; Choi, Ha Young

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.