SUPPLEMENTARY SENSORIMOTOR AREA SEIZURES IN CHILDREN AND ADOLESCENTS

Rationale: Some types of seizures in children may be difficult to reco gnize; the diagnosis of seizures arising near the mesial posterior fro ntal supplementary sensorimotor area (SSMA) may be especially challeng ing. Such seizures have been well described in adults, but few pediatr ic cases. have been reported even though onset is typically in childho od. Methods: We studied II children and adolescents with SSMA seizures diagnosed by prolonged video electroencephalography (EEG). Results: M ean age at onset was 5.8 years, and diagnosis by video EEG was made at a mean age of 12 years, Children had at least borderline intelligence and few abnormal findings on neurologic examination, Seizures were ty pically brief, frequent, and predominantly nocturnal, with bilateral t onic posturing, gross proximal limb movements, and preserved conscious ness, Magnetic resonance imaging showed normal findings or a superior or mesial posterior frontal tumor or cortical dysplasia, Routine EEG f indings were usually normal, but prolonged EEG showed epileptiform dis charges over the vertex, Seizure onset in the region of the SSMA was c onfirmed by subdural EEG in six patients who were studied for epilepsy surgery, Five patients had seizure-free outcome or worthwhile improve ment after operation, Two nonoperated patients are seizure-free on ant iepileptic medication, and three are undergoing surgical evaluation. C onclusions: Diagnosis of SSMA seizures in children may be challenging because of unusual symptoms (bilateral tonic limb involvement with pre served consciousness) and frequently normal routine EEG findings, Vide o EEG may be necessary for diagnosis, and magnetic resonance imaging m ay reveal a focal lesion, Increased recognition of this seizure type i n pediatric patients should lead to earlier diagnosis for optimal medi cal or surgical treatment.