Motor cortex relocation after complete anatomical hemispherectomy for intractable epilepsy secondary to Rasmussen's encephalitis

Br J Neurosurg. 2019 Apr;33(2):234-236. doi: 10.1080/02688697.2018.1549316. Epub 2019 Jan 17.

Abstract

Background: The authors report a case with interesting clinical and radiological outcomes following complete anatomical hemispherectomy.

Methods: A seven-year-old female with medically refractory epilepsy secondary to Rasmussen's encephalitis was treated with a complete right-sided anatomical hemispherectomy.

Results: Surgical intervention provided seizure relief, and at eleven-years post-operatively she was independently mobile, with spasticity of the upper limb. She had normal intellect and was pursuing higher education. Functional MRI found re-location of left-sided motor control to the remaining left hemisphere, alongside the existing motor cortex.

Conclusion: This interesting case is a good example of effective neuroplasticity; motor functionality relocated an area in the contralateral hemisphere that already contained the prerequisite cellular architecture and white matter connectivity required to control movement.

Keywords: Functional MRI (fMRI); Rasmussen's encephalitis; epilepsy; hemispherectomy.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Child
  • Drug Resistant Epilepsy / etiology
  • Drug Resistant Epilepsy / surgery*
  • Encephalitis / complications*
  • Female
  • Hemispherectomy / methods*
  • Humans
  • Inflammation / complications*
  • Magnetic Resonance Imaging
  • Motor Cortex / surgery*
  • Seizures / etiology
  • Seizures / surgery

Supplementary concepts

  • Rasmussen subacute encephalitis