Director of Brain Injury Rehab St Charles Hospital Port Jefferson, New York, United States
Case Diagnosis: Supplementary Motor Area Syndrome
Case Description: A 71-year-old female with multiple comorbidities presented with left arm tremors and cognitive deficits for about 2 years, MRI showed large falcine based meningioma with a mass effect on the frontal lobe. She underwent bilateral craniotomy and resection of meningioma, confirmed by pathology. On admission to an acute inpatient rehabilitation hospital, the patient lacked verbal output. She, was diagnosed with a supplementary motor area (SMA) syndrome due to the meningioma within the interhemispheric fissure abutting the SMA bilaterally. Patient received acupuncture treatment of the following points: Shenmeng, RN 23, bilateral ST 4 to 6, Left LI 15, LI 11, LI 4, ST 36, SP 6, Right LI 4, SP 6, 30 min/session, 5 days a week for 2 weeks. The patient cooperated with the therapy and had a significant improvement. On admission she ambulated 50 feet with moderates assistance of two therapists, on discharge, she ambulated 150 feet with supervision.
Discussions: The supplementary motor area (SMA) syndrome is a characteristic neurosurgical syndrome that may occur after unilateral resection of the SMA. The classical SMA syndrome, following unilateral resection of the SMA, is characterized by global akinesia with normo- or hyporeflexia and normal tonus, more profound on the contralesional side, while muscle strength can be preserved. Treatment is currently not very well defined. Multiple treatment options have been tried, such as dopamine receptor agonists, Zyprexa, Strattera, and Sinemet, etc. In this case, acupuncture has been tried with good effect.
Conclusions: Acupuncture can be a good treatment option for SMA syndrome, but further study is needed to establish the efficacy.