Insular cortex epilepsy in Rasmussen Syndrome: a case report

Case presentation: Male patient, 7 years old, first child of a non-consanguineous couple, previously healthy and with normal neuropsychomotor development, presented recurrent nausea vomiting associated facial paresthesia. Neurological examination was initially normal. 3 months after the onset condition, he started daily myoclonic seizures hospitalized for investigation. During clinical investigation, an electroencephalogram performed, which showed disorganized basal activity, frequent fronto-temporal epileptiform paroxysms in right cerebral hemisphere, propagation to contralateral homologous areas, magnetic resonance imaging that increase signal from cortex frontal lobe homolateral insula. On neurological examination, mild left hemiparesis noted. The patient progressed drug-resistant epilepsy control alteration atrophy compatible Rasmussen syndrome. He underwent immunoglobulin, pulse therapy methylprednisolone nine anti-seizure drugs, but no response. A video autonomic crises insular characteristics. Due poor seizure progression brain atrophy, hemispherectomy surgery indicated. As recurrence surgery, surgically approached twice more. After developed behavioral disorder hemiparesis.