SEIZURES WITH ONSET IN THE SENSORIMOTOR FACE AREA - CLINICAL-PATTERNSAND RESULTS OF SURGICAL-TREATMENT IN 20 PATIENTS

It is not generally appreciated that intractable seizures involving th e face area are amenable to surgical treatment. Twenty patients with o nset of sensorimotor seizures in the face area of the pre- and postcen tral gyri have been studied and surgically treated since 1948. Seizure s started in the face, tongue, or throat, followed by diverse patterns depending on spread of seizure activity. Two patients had epilepsia p artialis continua; 6 had either tonic or atonic drop attacks. All pati ents had pre- and postcentral face area resections, 12 in the dominant hemisphere. In addition, 3 had more extensive postcentral removal, 7 had temporal lobe, and 4 had small separate or contiguous frontal or p arietal resection. Because the seizures were not sufficiently reduced by the first operation, 6 required reoperation; 4 of these patients ha d residual epileptiform activity on electrocorticogram (ECoG) after th e first resection. Three patients had new neurologic signs that did no t return to the preoperative level, but in 2 of them the deficit relat ed mainly to higher resection in the central area. All but 2 of these 20 patients had at least moderate seizure reduction. Corticectomy can be performed for treatment of seizures arising in the lower central ar ea and usually does not lead to significant permanent neurologic defic it.