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Epilepsia partialis continua — SCE Neurology MCQ

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HardEpilepsyEpilepsia partialis continuaSCE Neurology

Continuous rhythmic twitching of the left hand persists for two days with preserved awareness. EEG shows focal discharges and MRI signal change in the right perirolandic cortex. Where is the seizure generator?

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Correct answer: E — Right primary motor cortex representing the left hand

The best answer is “Right primary motor cortex representing the left hand”. Persistent focal clonic activity with contralateral perirolandic abnormalities is epilepsia partialis continua arising from the right hand motor cortex. “Left cerebellar hemisphere” can be reasonable in another presentation, but it does not account for the defining feature here. “Right thalamic sensory relay” can be reasonable in another presentation, but it does not account for the defining feature here. “Left supplementary motor area” can be reasonable in another presentation, but it does not account for the defining feature here. “Right occipital cortex” can be reasonable in another presentation, but it does not account for the defining feature here.

Reference: ILAE operational classification of seizure types: https://pubmed.ncbi.nlm.nih.gov/28276060/