Periodic lateralized frontal epileptiform discharges with ipsilateral epilepsia partialis continua.

PURPOSE

Lateralized clonic jerks of the extremities during epileptic seizures usually arise from the contralateral rolandic cortex. In our exceptional case one-sided extremity twitches related to epileptiform activity in the ipsilateral frontal lobe.

METHODS

Case study with clinical-electroencephalographic correlation.

RESULTS

A 47-year-old man suffered destruction of most of his right cerebral hemisphere, including the perirolandic region. Epilepsia partialis continua (EPC) ensued, with clonic jerks of the proximal right upper and lower limbs temporally related to periodic lateralized epileptiform discharges (PLEDs) from the parasagittal region of the right frontal lobe with a variable time interval over 100 ms. Sectioning of the subcortical callosal and projection connections of the frontal lobe abolished the clonic jerks.

CONCLUSIONS

We propose the ipsilateral EPC arose from projections from the supplementary motor region to the medullary reticular formation to account for the long and variable latency between PLEDs and jerks.