Functional recovery following resection of an epileptogenic focus in the motor hand area

Despite recent technical advances, the surgical management of epileptic foci in the primary motor area, especially the motor hand area, Continues to represent a significant challenge because of the risk of permanent neurological deficit. We describe the case of a 19-year-old woman with intractable epilepsy secondary to cortical dysplasia of the motor hand area who was treated with surgical resection. The patient showed immediate complete motor deficit, started improving at around I month of follow-up, and had a substantial recovery at 6 months, with only mild limitations of fine hand movements. At the latest follow-up (3 years), she remained seizure-free. This case demonstrates that, in selected cases, resections in the primary motor cortex can be performed and that the immediately observed motor deficit is transient. We discuss the proposed mechanisms for recovery based on available data from experimental animal and clinical human studies. (C) 2007 Elsevier Inc. All rights reserved.