Acquired dysgraphia in a girl with subcortical band heterotopia
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Acquired dysgraphia in a girl with subcortical band heterotopia Shan‑Ju Lin1 · Wei‑Sheng Lin2,3 Received: 10 July 2020 / Accepted: 19 September 2020 © Belgian Neurological Society 2020
Keywords Dysgraphia · Band heterotopia · Topiramate A 17-year-old girl has had seizures since she was 5 years old. Brain magnetic resonance imaging revealed subcortical band heterotopia (“double cortex”, Fig. 1). She had been treated with several antiepileptic medications; however, seizures still occurred occasionally. She was started on topiramate at the age of 12. After serial up-titration of topiramate, her mother noted that the patient had more emotional outbursts, and her handwriting became "wilder" and not obeying the lines. Her dysgraphia profile was mixed, with both spatial and dysexecutive features. The latter was exemplified by repetition of strokes that was often seen in
various kinds of her writing, including English (Fig. 2a), Chinese characters (Fig. 2b), and Arabic numbers. Dysgraphia means impaired handwriting, which could be developmental or acquired [1]. Dysgraphia is commonly seen in neurologically impaired children, yet it is often underappreciated. The neurobiological basis of writing disorders remains incompletely understood [2–4]. The temporal association between topiramate use and writing problems in this patient suggested that her dysgraphia was drug related, although we did not find any report of similar phenomenon in the literature. Owing to the unfavorable
* Wei‑Sheng Lin [email protected] 1
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
2
Department of Pediatrics, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 11217, Taiwan
3
Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
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Vol.:(0123456789)
Acta Neurologica Belgica
Fig. 1 Brain magnetic resonance imaging of the patient a axial view; b sagittal view
Fig. 2 Representative records of handwriting of the patient, demonstrating her evolving writing performance a English vocabulary, from her schoolwork; (b and c) Chinese characters, from her letters to the doctor, before and after discontinuation of topiramate, respectively; d
handwriting of a typically-developing adolescent girl, for comparison, with its English translation in parenthesis. Examples of dysexecutive dysgraphia, which was prominent in a and b, were indicated by arrows
responses described above, we tapered off topiramate after adding on levetiracetam. Overall writing performance of the
patient improved afterward (Fig. 2c), whereas seizures still happened to her almost every month.
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Acta Neurologica Belgica Author contributions WSL cared for the patient. SJL and WSL did literature search and prepared the figures. WSL wrote the initial draft of the manuscript. SJL and WSL edited the manuscript and approved its final form. Informed consent for publication was obtained from the patient and
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