Facial myoclonus presenting as epilepsia partialis continua in a patient with an opercular lésion

A. Estraneo, R. Meo, L. Bilo, A. Filla, S. Striano

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Introduction An authentic facial myoclonus without involvement of any other body part is very rare. The most common condition associated with it is epilepsia partialis continua (EPC). A recurring question has been whether EPC diagnosed clinically is caused by discharges arising in the cerebral cortex or in subcortical structures. Case report A 40-year-old right-handed male presented, at the age of 30 years, subcontinuous simple partial seizures, involving the left face and tongue associated with salivation. He later developed a rhythmic twitching of his left lower face and tongue. At the present time, he has subcontinuous facial myoclonus with no response to anticonvulsants and occasional opercular seizures, usually coin-ciding with drug withdrawal. MRI and SPECT of the brain show a fixed right opercular lesion. A surface EEGvideo evaluation, with bilateral electromyography (EMG) recordings of the myoclonus of the left lower face, shows no evidence of cortical epileptiform activity. Spontaneous rhythmic jerks occur with short EMG bursts (<50 ms duration) in left tongue/lips at a frequency of 8-9 Hz. The jerking increases in amplitude and frequency during voluntary movements such as speaking or eating. The silent period after magnetic stimulation over the right motor cortex is shorter than in normal subjects. Discussion In this patient a known etiology and the static course of the symptomatology are typical of the first type of Kojewnikow's syndrome (Bancaud, 1984). In our patient, the role of proprioceptive factors has been noted, such as triggered myoclonus, suggesting a form of reflex myoclonus. In this case, clinical, electrophysiologic and radiologie data suggest a cortical origin of facial myoclonus.

Original languageEnglish
Pages (from-to)345
Number of pages1
JournalItalian Journal of Neurological Sciences
Issue number5
Publication statusPublished - 1999

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology


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