MULTIPLE SUBPIAL TRANSECTIONS FOR PARTIAL SEIZURES IN SENSORIMOTOR CORTEX

WE REPORT SIX patients with complex partial seizures arising from the primary sensorimotor cortex who underwent invasive long-term ictal ele ctroencephalogram/video monitoring and brain mapping and then multiple subpial transections. Although four patients demonstrated no abnormal ities on magnetic resonance imaging, each patient showed moderate to m arked gliosis in cortex biopsied from the site of ictal onset. Extensi ve preoperative and postoperative neuropsychological tests demonstrate d no functional deficits resulting from surgery. Only one patient fail ed to derive significant postoperative seizure improvement, and he sub sequently underwent additional subpial sectioning without further sign ificant improvement. We propose a modification for this surgical techn ique and hypothesize that these patients may represent a syndrome of c entral cortical epilepsy.