Accelerated myelination with motor system involvement in a neonate with immediate postnatal onset of seizures and hemimegalencephaly

The timetable for normal myelination in the developing brain on MRI is well described. Beyond the genetically determined myelination process, environmental or other incidental factors may modulate the actual myelination, globally or regionally. Delayed myelination is well known in many pathological conditions interfering with adequate energy or myelin precursor supply. Rare but specific conditions where the normal process of myelination is accelerated are also known. We describe a case of early postnatal epilepsy demonstrating a striking degree of accelerated myelination both in the cerebral tissue adjacent to the presumed epileptic focus and along the ipsilateral pyramidal tract through the brainstem, a feature not previously described in the literature. This distal myelination highlights the peculiar system involvement pattern of function-induced myelination rather than simply regional myelination in response to an epileptic or other stimulus. This may have implications on our understanding of the development of function systems (visual, auditory, motor, sensory, etc.) or even the more complex interactive process of learning and may open new therapeutic opportunities in pathological functional conditions previously believed to be incurable.