Document Detail


The value of intraoperative electrocorticography in surgical decision making for temporal lobe epilepsy with normal MRI.
MedLine Citation:
PMID:  21480886     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We hypothesized that acute intraoperative electrocorticography (ECoG) might identify a subset of patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE) who could proceed directly to standard anteromesial resection (SAMR), obviating the need for chronic electrode implantation to guide resection.
METHODS: Patients with TLE and a normal MRI who underwent acute ECoG prior to chronic electrode recording of ictal onsets were evaluated. Intraoperative interictal spikes were classified as mesial (M), lateral (L), or mesial/lateral (ML). Results of the acute ECoG were correlated with the ictal-onset zone following chronic ECoG. Onsets were also classified as "M,""L," or "ML." Positron emission tomography (PET), scalp-EEG (electroencephalography), and Wada were evaluated as adjuncts.
KEY FINDINGS: Sixteen patients fit criteria for inclusion. Outcomes were Engel class I in nine patients, Engel II in two, Engel III in four, and Engel IV in one. Mean postoperative follow-up was 45.2 months. Scalp EEG and PET correlated with ictal onsets in 69% and 64% of patients, respectively. Wada correlated with onsets in 47% of patients. Acute intraoperative ECoG correlated with seizure onsets on chronic ECoG in all 16 patients. All eight patients with "M" pattern ECoG underwent SAMR, and six (75%) experienced Engel class I outcomes. Three of eight patients with "L" or "ML" onsets (38%) had Engel class I outcomes.
SIGNIFICANCE: Intraoperative ECoG may be useful in identifying a subset of patients with MRI-negative TLE who will benefit from SAMR without chronic implantation of electrodes. These patients have uniquely mesial interictal spikes and can go on to have improved postoperative seizure-free outcomes.
Authors:
Neal Luther; Elayna Rubens; Nitin Sethi; Padmaja Kandula; Douglas R Labar; Cynthia Harden; Kenneth Perrine; Paul J Christos; J Bryan Iorgulescu; Guido Lancman; Neil S Schaul; Dmitriy V Kolesnik; Shahin Nouri; Andrew Dawson; Apostolos J Tsiouris; Theodore H Schwartz
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2011-04-11
Journal Detail:
Title:  Epilepsia     Volume:  52     ISSN:  1528-1167     ISO Abbreviation:  Epilepsia     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-12     Completed Date:  2011-07-14     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  United States    
Other Details:
Languages:  eng     Pagination:  941-8     Citation Subset:  IM    
Copyright Information:
Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.
Affiliation:
Department of Neurological Surgery, Weill Cornell Medical College, New York, New York 10065, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Decision Making*
Electrodes, Implanted
Electroencephalography / methods*,  statistics & numerical data
Epilepsy, Temporal Lobe / diagnosis*,  psychology,  surgery*
Female
Humans
Magnetic Resonance Imaging / statistics & numerical data*
Male
Middle Aged
Monitoring, Intraoperative / methods*
Neurosurgical Procedures / methods*,  standards
Treatment Outcome
Grant Support
ID/Acronym/Agency:
UL1 RR024996/RR/NCRR NIH HHS; UL1-RR024996/RR/NCRR NIH HHS
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