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Implantation of subdural electrodes on the brain surface is still widely performed as one of the “gold standard methods” for the presurgical evaluation of epilepsy. Stereotactic insertion of depth electrodes to the brain can be added to detect brain activities in deep-seated lesions to which surface electrodes are insensitive. This study tried to clarify the efficacy and limitations of combined implantation of subdural and depth electrodes in intractable epilepsy patients. Fifty-three patients with drug-resistant epilepsy underwent combined implantation of subdural and depth electrodes for long-term intracranial electroencephalography (iEEG) before epilepsy surgery. The detectability of early ictal iEEG change (EIIC) were compared between the subdural and depth electrodes. We also examined clinical factors including resection of MRI lesion and EIIC with seizure freedom. Detectability of EIIC showed no significant difference between subdural and depth electrodes. However, the additional depth electrode was useful for detecting EIIC from apparently deep locations, such as the insula and mesial temporal structures, but not in detecting EIIC in patients with ulegyria (glial scar). Total removal of MRI lesion was associated with seizure freedom. Depth electrodes should be carefully used after consideration of the suspected etiology to avoid injudicious usage.

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Summary: The effect of fluid percussion injury (FPI) on the propagation of neuronal activity in the rat hippocampus was investigated by using optical and extracellular recording techniques. Under anesthesia with pentobarbital sodium, a moderate impact (1.5-2.0 atm) was applied to the parietal cerebral cortex of the left hemisphere at -3 mm (i.e. caudal) from bregma, 3.5 mm lateral from the sagittal suture. Systemic oxygenation remained normal during the anesthesia. The rats recovered fully from anesthesia within 30-60 min, and their subsequent behavior, such as feeding and grooming, was normal. After a survival period of 1 week from the FPI or sham-operation, neuronal activities were recorded from the hippocampal CA1 region and the dentate gyrus (DG) in either coronal or horizontal brain slice preparations. In sham-operated rats, there was no significant difference in the neuronal activity between contralateral and ipsilateral hippocampal CA1 areas and DG. In corona) slices (-5.6--6.4 mm from bregma), moderate impact (1.5-2.0 atm) markedly depressed the neuronal activity of the ipsilateral (impact side) CA1 region and of the DG directly under the cerebral cortex that received the impact. In horizontal slices, on the other hand, the neuronal activity was markedly enhanced in the ipsilateral hippocampal CA1 region and the DG adjacent the temporal lobe of the cerebral cortex. Field potentials were recorded from the dentate granule cell layer and the hippocampal CA1 pyramidal cell layer in either coronal or horizontal slice. Moderate impact strongly depressed the field potential in the ipsilateral CA1 region and DG directly under the injured cerebral cortex. In horizontal slices, the field potential was followed by multiple population spikes in ipsilateral hippocampal CA1 and the DG neurons. Bicuculline (15 pM) increased the number of spikes of the field potential even after the brain injury. These results suggest that FPI depresses the neuronal activity in the ipsilateral hippocampus directly under the injured parietal cortex, while it enhances the neuronal activity of the ipsilateral hippocampus adjacent to the temporal cortex. The facilitation of neuronal activity following FPI is not due to disinhibition resulting from depression of GABAergic interneuron activity.