Paradoxical Improvement in Hemiplegia Following Cortical Excision

Abstract

Three patients required treatment for seizures related to long-standing lesions in the Rolandic area and hemiplegia. The injured cortex was removed, in the hope that relief from seizures would more than outweigh the expected increase in functional disability of the hemiplegic limbs. As an unexpected result, excision of the injured but still excitable cortex in the region of the Rolandic fissure resulted in decreased spasticity and paradoxical improvement in the use of the limbs. The authors stress the fact that these unexpected results were due to the removal of abnormal sensorimotor gyri. The bearing of these observations on the still obscure mechanisms involved in reorganization of function following cortical injury are discussed.