Document Detail


Single pulse electrical stimulation for identification of structural abnormalities and prediction of seizure outcome after epilepsy surgery: a prospective study.
MedLine Citation:
PMID:  16239178     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Abnormal late responses to single pulse electrical stimulation (SPES) in patients with intracranial recordings can identify epileptogenic cortex. We aimed to investigate the presence of neuropathological abnormalities in abnormal SPES areas and to establish if removal of these areas improved postsurgical seizure control. METHODS: We studied abnormal responses to SPES during chronic intracranial recordings in 40 consecutive patients who were thereafter operated on because of refractory epilepsy and had a follow-up period of at least 12 months. FINDINGS: 22 patients had abnormal responses to SPES exclusively located in resected regions (96% with favourable outcome), seven had abnormal responses to SPES located in resected and non-resected regions (71% with favourable outcome), three had abnormal responses to SPES exclusively outside the resected region (none with favourable outcome), and eight did not have abnormal responses to SPES (62.5% with favourable outcome). Surgical outcome was significantly better when areas with abnormal responses to SPES were completely resected compared with partial or no removal of abnormal SPES areas (p=0.006). Neuropathological examination showed structural abnormalities in the abnormal SPES areas in 26 of the 29 patients in whom these regions were resected, despite the absence of clear MRI abnormalities in nine patients. INTERPRETATION: Abnormal responses to SPES are functional markers of epileptogenic structural abnormalities, and can identify epileptogenic cortex and predict surgical outcome, especially when a frontal or temporal focus is suspected.
Authors:
Antonio Valentín; Gonzalo Alarcón; Mrinalini Honavar; Jorge J García Seoane; Richard P Selway; Charles E Polkey; Colin D Binnie
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet neurology     Volume:  4     ISSN:  1474-4422     ISO Abbreviation:  Lancet Neurol     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-10-21     Completed Date:  2005-11-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  101139309     Medline TA:  Lancet Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  718-26     Citation Subset:  IM    
Affiliation:
Department of Clinical Neurophysiology, Guy's, King's and St Thomas' School of Medicine, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Brain Neoplasms / complications,  surgery
Cerebral Cortex / pathology
Child
Child, Preschool
Electric Stimulation
Electrodes, Implanted
Electrodiagnosis*
Electroencephalography
Female
Frontal Lobe / surgery
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neurosurgical Procedures*
Prospective Studies
Seizures / diagnosis*,  pathology,  surgery*
Temporal Lobe / surgery
Treatment Outcome

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


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