Successful treatment of intractable epilepsia partialis continua with multiple subpial transections

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Abstract
Cortical dysplasia is increasingly being recognised as an important cause of partial seizures including epilepsia partialis continua. With the advent of high resolution MRI it is now often possible to identify areas of cortical dysplasia, increasing the possibility of neurosurgical intervention when seizures are refractory to medical treatment. We present a patient with intractable epilepsia partialis continua due to cortical dysplasia that was refractory to all medical treatments, was not evident on MRI, and was dramatically improved by multiple subpial transections. Photomicromicrographs of the excised specimens. (A) Showing dysplastic cortex with disordered cortical lamination, malorientated nerve cells, and focal clustering (haematoxylin and eosin, originally ×160, bar represents 25 μm). (B) Showing large dysplastic nerve cells (haematoxylin and eosin, originally ×400, bar represents 62.5 μm). A 19 year old man who was the product of an uneventful pregnancy with no perinatal problems and normal early milestones developed simple partial seizures at the age of 14 years. These comprised clonic movements of the left side of his face, left arm, and left leg. Brain MRI was reported as normal and an EEG showed a right frontoparietal focus. Carbamazepine was started at a dose of 800 mg daily and he remained seizure free for a year. A subsequent …