Abstracts

Rationale: The relationship between medial temporal lobe seizures and contralateral focal dystonia is a well recognized phenomenon, however its pathway is not well understood. We describe 2 patients with focal refractory epilepsy and contralateral focal dystonia whose focal dystonia significantly improved after medial temporal lobectomy. Methods: Two patients were identified within the Mount Sinai Health system who had a significant improvement in focal dystonia after medial temporal lobectomy. Retrospective chart reviews for the clinical history and exam, EEG reports, and imaging were performed. Results: The first patient is a 29 year old man who suffered from a motor vehicle accident resulting in a traumatic brain injury mostly involving the right temporal lobe. Within a year he developed left hand and foot dystonia as well as seizures described as feeling fearful and hot with heart palpitations. For his medically refractory epilepsy he received a right amygdala-hippocampectomy. Immediately after the surgery, his focal dystonia was resolved. The second patient is a 28 year old man who has a history of right temporal low grade glioma resection complicated by an infarct of the right basal ganglia and internal capsule resulting in left arm and foot dystonia and spasticity. Later he received a right medial temporal resection for his refractory epilepsy. After the surgery, his focal dystonia was nearly resolved. Conclusions: Our two cases demonstrate a medial temporal ?" basal ganglia network dysfunction in focal dystonia. The resection of medial temporal structure may have interfered with this network, modulating abnormal motor circuit. We hope that these cases shed more insight into the functional networks between the medial temporal structure and basal ganglia pathway. Funding: None