Ictal hemiparesis

Two subjects with ictal hemiparesis are described. Both children presented with evolving paresis associated with seizure activity. Structural neuroima ging remained consistently normal, although EEG demonstrated slow-wave acti vity, and SPECT scanning in one child showed perfusion asymmetry. Both chil dren had resolution of the hemiparesis when seizure activity was adequately controlled. The historically proposed pathophysiology of ictal hemiparesis is that of inhibition of the somatosensory and motor areas of the cortex, The presence of an evolving hemiparesis and seizure activity associated wit h normal neuroimaging should prompt consideration of ictal hemiparesis, Con firmation of this rare diagnosis can only be made when seizure control lead s to resolution of the paresis.