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Characterization of the Supplementary Motor Area Syndrome and Seizure Outcome After Medial Frontal Lobe Resections in Pediatric Epilepsy Surgery

Kasasbeh, Aimen S. MD*; Yarbrough, Chester K. MD; Limbrick, David D. MD, PhD; Steger-May, Karen MA§; Leach, James L. MD; Mangano, Francesco T. DO; Smyth, Matthew D. MD

doi: 10.1227/NEU.0b013e31823f6001
Research-Human-Clinical Studies
CNS University of Neurosurgery

BACKGROUND: In adults, resection of the medial frontal lobe has been shown to result in supplementary motor area (SMA) syndrome, a disorder characterized by transient motor impairment. Studies examining the development of SMA syndrome in children, however, are wanting.

OBJECTIVE: To characterize the development of SMA syndrome and to analyze seizure outcomes after surgery in the medial frontal lobe for medically intractable epilepsy.

METHODS: Thirty-nine patients with medically intractable epilepsy who underwent surgery in the medial frontal lobe were reviewed retrospectively. The progression of neurological impairment and seizure outcome after surgery was recorded, and the extent of cortex resected was analyzed.

RESULTS: After resection in the region of the SMA, 23 patients (59%) developed postoperative neurological impairment; 17 (74%) were identified as SMA syndrome. No neurological impairment was found after surgery in 16 patients (41%). Six patients (15%) experienced permanent neurological impairment. The majority of patients (82%) who developed SMA syndrome had resolution of their symptoms by 1 month postoperatively. Preoperative magnetic resonance imaging finding of lesional cases was associated with a significantly decreased likelihood of developing SMA syndrome (P = .02). Seizure outcome was favorable after surgery in most patients.

CONCLUSION: Surgery for medically intractable epilepsy in the region of the medial frontal cortex is effective and associated with reversible neurological impairment in children. All patients had resolution of their SMA syndrome by 6 months postoperatively.

*Department of Neuroscience, University of Arizona, Tucson, Arizona

Department of Neurological Surgery, Saint Louis Children's Hospital and

§Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri

Department of Medical Imaging and

Department of Neurological Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Correspondence: Aimen S. Kasasbeh, MD, Department of Neuroscience, University of Arizona, 1548 E Drachman St, PO Box 210476, Tucson, AZ 85719. E-mail:

Received June 17, 2011

Accepted October 15, 2011

Copyright © by the Congress of Neurological Surgeons