Disclosures: Giorgio A. Negron, MD: No financial relationships or conflicts of interest

Case Description: This patient underwent a planned stereotactic laser ablation (SLA) of the right cingulate gyrus after localization of her seizures with stereo-electroencephalography (sEEG). She was taken to an intraoperative MRI suite where the procedure was performed without complication. While in the PACU recovery area, the patient awoke and was noted to have left-sided hypokinesia (proximal and distal strength examination notable for 3/5 upper extremity and 2/5 lower extremity). Otherwise, muscle tone, fine touch and pain/temperature sensation were preserved. Postoperative MRI showed expected procedural changes from the right cingulate laser ablation without any evidence of acute infraction or hemorrhage. She was diagnosed with supplementary motor area (SMA) syndrome and was evaluated by therapy teams who recommended acute inpatient rehabilitation.

Setting: Inpatient Rehabilitation Hospital

Patient: A right-handed 19-year-old girl with history of refractory epilepsy Assessment/

Results: Patient was transferred to inpatient rehabilitation 3 days post-operatively where she gradually improved her left sided strength and coordination. She progressed to ambulation with a walker and was discharged home two weeks later. She will undergo outpatient physical therapy for 4 weeks and follow up with outpatient PM&R.

Discussion: The SMA is located anterior to the primary motor cortex and plays a key role in motor action sequencing. Disruption of this area causes a transient global akinesia of the contralateral side with dominant lesions also producing reduced speech or mutism. Given that SMA syndrome typically presents after tumor resection or stroke, this is a unique case that describes SMA syndrome after SLA of a proximal location within the cingulate gyrus.

Conclusion: SMA syndrome is a temporal impairment that may mimic other neurological presentations. Based on this patient’s early motor recovery, we expect a near to complete recovery.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/development-of-supplementary-motor-area-syndrome-after-stereotactic-laser-ablation-for-refractory-epilepsy-a-case-report/