Refractory focal motor seizures controlled with intramuscular botulinum toxin

Abstract

Patients with recurrent focal motor seizures present a management dilemma, as anti-convulsants are often ineffective, and resective surgery poses a high risk of motor deficit. We describe three patients with recurrent focal motor seizures that remained refractory despite numerous anti-convulsant trials. All patients showed either hyperperfusion on Single-Photon Emission Computerised Tomography (SPECT) or hypermetabolism on Positron Emission Tomography (PET) in primary motor cortex during periods of sustained jerking, although EEG abnormalities were uncommon. After botulinum toxin (BoT) injection there was a rapid and dramatic reduction in seizure frequency in all patients despite minimal lim..