Transient opercular syndrome: a manifestation of uncontrolled epileptic activity

Newly appearing oral motor apraxia should alert physicians to the possibili ty of an organic lesion in the operculum, the perisylvanian cortex. A 6 1/2 -year-old boy who is being followed for complex partial seizures with secon dary generalization failed to respond to carbamazepine and then to the addi tion of sodium valproate. The further addition of lamotrigine stopped the s eizures but the patient presented with a new onset of opercular syndrome, m anifested by severe oral motor apraxia with difficulties in chewing and swa llowing and speech. MRI study of the brain revealed no abnormalities. The o percular syndrome resolved completely when the lamotrigine was replaced wit h phenobarbital, and did not recur during the follow-up period of 2 years. The EEG, however, continued to be abnormal. We conclude that opercular synd rome may be a manifestation of abnormal localized electrical activity at th e operculum, even in the absence of an organic lesion on imaging studies, a nd it may be a marker for an epilepsy which is not easily controlled.