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Neurology 2002;58:246-249
© 2002 American Academy of Neurology

Botulinum toxin-induced paralysis of frontotemporal muscles improves seizure focus localization

S. Eisenschenk, MD, R. L. Gilmore, MD, B. Uthman, MD, E. Valenstein, MD and R. Gonzalez, MD

From the Department of Neurology (Drs. Eisenschenk, Gilmore, Uthman, Valenstein, and Gonzalez), University of Florida, Gainesville; and Malcolm Randall Department of Veterans Affairs Medical Center (Dr. Uthman), North Florida/South Georgia Veteran Health System, Gainesville.

Address correspondence and reprint requests to Dr. Stephan Eisenschenk, University of Florida, McKnight Brain Institute, 100 South Newell Drive, Room L3-100, Gainesville, FL 32610-0236; e-mail: eisensj{at}neurology.ufl.edu

Background: Scalp EEG localization of epileptic foci may be obscured by electromyographic (EMG) artifact produced by ictal contraction of cranial muscles. Injection of botulinum toxin type A (BTX-A) into frontotemporal scalp muscles reduces EMG activity. Initial scalp video-EEG monitoring in three patients suggested partial seizures, but definitive lateralization or localization was precluded by EMG artifact.

Methods: EMG-guided BTX-A injection to bilateral frontotemporal muscles was performed. When artifact persisted, BTX-A administration was selectively repeated. Patients subsequently underwent scalp video-EEG monitoring 1 week later.

Results: All patients had reduction of EMG artifact during subsequent scalp video-EEG monitoring. No patient had adverse effects after BTX-A administration. All three patients had localization to either frontal or temporal lobes and definitive lateralization. Two of the three patients were able to proceed to invasive placement of frontotemporal subdural grid electrodes based on the BTX-A scalp video-EEG localization, and the third patient was determined to have a multifocal seizure disorder.

Conclusions: Paralysis of frontotemporal scalp muscle after BTX-A administration reduces EMG artifact and may improve localization and lateralization of a seizure focus, providing a noninvasive technique for advancement toward epilepsy surgery.




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J Jankovic
Botulinum toxin in clinical practice
J. Neurol. Neurosurg. Psychiatry, July 1, 2004; 75(7): 951 - 957.
[Abstract] [Full Text] [PDF]


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