Document Detail

Magnetoencephalography using total intravenous anesthesia in pediatric patients with intractable epilepsy: lesional vs nonlesional epilepsy.
MedLine Citation:
PMID:  18842368     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Magnetoencephalography (MEG) provides source localization of interictal spikes. We use total intravenous anesthesia (TIVA) with propofol to immobilize uncooperative children. We evaluate the effect of TIVA on interictal spikes in children who have intractable epilepsy with or without MRI lesions. METHODS: We studied 28 children (3-14 years; mean, 6.6). We intravenously administered propofol (30-60 microg/kg/min) to record MEG with simultaneous EEG. We evaluated MEG spike sources (MEGSSs). We compared spikes on simultaneous EEG under TIVA with those on scalp video-EEG without TIVA. RESULTS: There was a significant decrease in frequent spikes (10 patients, 36%) on simultaneous EEG under TIVA compared to those (22 patients, 79%) on scalp video-EEG without TIVA (P<0.01). MEGSSs were present in 21 (75%) of 28 patients. Clustered MEGSSs occurred in 15 (83%) of 18 lesional patients but in 3 (30%) of 10 nonlesional patients (P<0.05). MEGSSs were more frequently absent in nonlesional (6 patients, 60%) than lesional (one patient, 5%) patients (P<0.01). Thirteen patients with MRI and/or histopathologically confirmed neuronal migration disorder most frequently showed clustered MEGSSs (11 patients, 85%) compared to those of other lesional and nonlesional patients. CONCLUSION: Propofol-based TIVA reduced interictal spikes on simultaneous EEG. TIVA for MEG still had utility in identifying spike sources in a subset of pediatric patients with intractable epilepsy who were uncooperative and surgical candidates. In lesional patients, MEG under TIVA frequently localized the clustered MEGSSs. Neuronal migration disorders were intrinsically epileptogenic and produced clustered MEGSSs under TIVA. Nonlesional patients often had no MEGSS under TIVA.
Ayataka Fujimoto; Ayako Ochi; Katsumi Imai; Derrick Chan; Rohit Sharma; Amrita Viljoen; Bill Chu; Stephanie Holowka; Sheelagh M Kemp; Sylvester H Chuang; Akira Matsumura; Satoshi Ayuzawa; O Carter Snead; Hiroshi Otsubo
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-10-07
Journal Detail:
Title:  Brain & development     Volume:  31     ISSN:  1872-7131     ISO Abbreviation:  Brain Dev.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-16     Completed Date:  2009-02-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7909235     Medline TA:  Brain Dev     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  34-41     Citation Subset:  IM    
The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8.
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MeSH Terms
Action Potentials / drug effects
Anesthesia, Intravenous / methods
Anesthetics, Intravenous / administration & dosage,  pharmacology
Brain / pathology,  physiopathology*
Brain Mapping / methods
Child, Preschool
Electroencephalography / methods
Epilepsies, Partial / diagnosis,  physiopathology
Epilepsy / classification,  diagnosis,  physiopathology*
Epilepsy, Generalized / diagnosis,  physiopathology
Magnetic Resonance Imaging
Magnetoencephalography / methods*
Piperidines / administration & dosage,  pharmacology
Propofol / administration & dosage,  pharmacology*
Seizures / classification,  diagnosis,  physiopathology
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Piperidines; 132875-61-7/remifentanil; 2078-54-8/Propofol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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