Association of intracranial abnormalities with the development of epilepsy and drug-resistant epilepsy in patients with Parry-Romberg syndrome

Charlene L. Gunasekera, Erik H. Middlebrooks, David B. Burkholder, Baibing Chen, Joseph I. Sirven, Lily C. Wong-Kisiel, Brin E. Freund, William O. Tatum, Cynthia C. De la Garza-Ramos, Lela Okromelidze, Anteneh M. Feyissa

Research output: Contribution to journalArticlepeer-review


Background: Epilepsy represents an essential component of Parry Romberg syndrome (PRS). This study aimed to identify clinical factors that influence the development of epilepsy and drug-resistant epilepsy (DRE) in PRS. Methods: We retrospectively reviewed the medical records of eighty patients with PRS. Data including the age of onset for PRS, history of seizures, use and timing of immunotherapy, antiseizure medication use, and EEG and brain imaging findings were reviewed. For comparison with the patients with epilepsy (PRSe+) group, we selected 18 age and sex-matched controls from the patient without epilepsy (PRSe-) cohort using propensity score matching. Results: Eighteen (22.5%) had epilepsy: 12 were female, and the median age was 14.5 years (range = 6–48 years). Eleven patients developed DRE. The median latency between the onset of cutaneous manifestations and diagnosis and timing and use of immunotherapy was similar between the PRSe + and PRSe- groups. Intracranial abnormalities were commonly seen in the PRSe + group (16 vs. 2, p < 0.01). White matter disease and ipsilateral atrophy were common among the PRSe + group. Timing and use of immunotherapy, epileptiform discharges, and brain imaging abnormalities did not differ between those with DRE and without. Conclusions: The presence and degree of severity of ipsilateral brain abnormalities are risk factors for the development of epilepsy in PRS but not factors in predicting drug resistance. The timing of immunotherapy did not influence the development of PRSe + or DRE. Prospective studies are needed to identify biomarkers for epilepsy and assess the role of immunotherapy on seizure outcomes in PRSe +.

Original languageEnglish (US)
Article number120455
JournalJournal of the neurological sciences
StatePublished - Nov 15 2022


  • Drug-resistant epilepsy
  • Hemifacial atrophy
  • Immune-mediated seizures
  • Intracranial abnormalities
  • Parry-Romberg syndrome
  • Symptomatic epilepsy
  • White matter disease

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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