Intra-operative electrocorticography in lesional epilepsy

Tripathi, Manjari; Garg, Ajay; Gaikwad, Shailesh; Bal, Chandrasekhar; Sarkar, Chitra; Prasad, Kameshwar; Dash, Hari H.; Sharma, Bhawani S.; Chandra, P. Sarat

doi:10.1016/j.eplepsyres.2009.12.007

Cited by 96 publications

(89 citation statements)

References 49 publications

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“…Once a patient was diagnosed as having drug-resistant epilepsy, MRI as per epilepsy protocol (Siemens Magnetom Sonata 1.5 T, Philips Achieva 3.0 T TX) was performed if the earlier performed MRI was not found satisfactory [12,14]. Subsequently, a short- or long-term VEEG (Nicolet One LTM 64,128) was performed to record at least 3 habitual seizures.…”

Section: Methodsmentioning

confidence: 99%

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Epilepsy Surgery in a Pediatric Population: A Retrospective Study of 129 Children from a Tertiary Care Hospital in a Developing Country along with Assessment of Quality of Life

Dagar¹,

Chandra²,

Chaudhary³

et al. 2011

Pediatr Neurosurg

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Purpose: To assess the outcome of a pediatric population operated for drug-resistant epilepsy from a large tertiary care center in India. Methods: Retrospectively: quality of life (QOL); prospectively: preoperative assessment included interictal EEG, MRI (as per epilepsy protocol), video-EEG. Ictal SPECT (with subtraction) and PET were performed when required. QOL scores were assessed using the HASS or SSQ for seizure severity, Quality of Life in Childhood Epilepsy (QOLCE) for QOL, and Child Behavior Check List (CBCL) for behavior. Results: 142 were operated from January 2000 to June 2011 by the senior author. 118 patients with at least 1 year of follow-up were included in the study. Mean age at surgery was 9.8 ± 4.3 years. In addition, 40 patients underwent QOL assessment prospectively both before and after surgery. Mean duration of epilepsy was 5.3 ± 3.3 years. A class I outcome (Engel’s) was seen in 79.5% patients, class II in 8.6%, class III in 10.7%, and class IV in 1 patient. As per surgical procedures, class I outcome in patients who underwent temporal resection, hemispherotomy and extratemporal resection was 76, 87 and 72%, respectively. QOL scores correlated with duration of seizures, epileptic encephalopathy and outcome of surgery, but not with side of surgery, age and sex. Conclusions: This study, the largest reported from India, has demonstrated satisfactory results for epilepsy surgery in children.

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Section: Methodsmentioning

confidence: 99%

“…MRI with PET co-registration was also preferred for either substrate-negative pathologies or for tuberous sclerosis [15]. Electrocorticography was used in most of the cases at surgery, both before and after resection [14]. …”

Section: Methodsmentioning

confidence: 99%

Epilepsy Surgery in a Pediatric Population: A Retrospective Study of 129 Children from a Tertiary Care Hospital in a Developing Country along with Assessment of Quality of Life

Dagar¹,

Chandra²,

Chaudhary³

et al. 2011

Pediatr Neurosurg

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“…18,19 The use of ECoG in epilepsy surgery specifically for MRI-negative TLE has not been extensively evaluated. Most studies have focused on ECoG in lesional epilepsy including mesial temporal sclerosis (MTS), 17,20,21 contained heterogeneous patient groups, 9,16-18,22 or involved relatively small numbers of patients. 10,15 …”

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confidence: 99%

Interictal Scalp Electroencephalography and Intraoperative Electrocorticography in Magnetic Resonance Imaging–Negative Temporal Lobe Epilepsy Surgery

et al. 2014

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IMPORTANCE Scalp electroencephalography (EEG) and intraoperative electrocorticography (ECoG) are routinely used in the evaluation of magnetic resonance imaging-negative temporal lobe epilepsy (TLE) undergoing standard anterior temporal lobectomy with amygdalohippocampectomy (ATL), but the utility of interictal epileptiform discharge (IED) identification and its role in outcome are poorly defined.OBJECTIVES To determine whether the following are associated with surgical outcomes in patients with magnetic resonance imaging-negative TLE who underwent standard ATL:(1) unilateral-only IEDs on preoperative scalp EEG; (2) complete resection of tissue generating IEDs on ECoG; (3) complete resection of opioid-induced IEDs recorded on ECoG; and (4) location of IEDs recorded on ECoG. DESIGN, SETTING, AND PARTICIPANTS Data were gathered through retrospective medical record review at a tertiary referral center. Adult and pediatric patients with TLE who underwent standard ATL between January 1, 1990, and October 15, 2010, were considered for inclusion. Inclusion criteria were magnetic resonance imaging-negative TLE, standard ECoG performed at the time of surgery, and a minimum follow-up of 12 months. Univariate analysis was performed using log-rank time-to-event analysis. Variables reaching significance with log-rank testing were further analyzed using Cox proportional hazards. MAIN OUTCOMES AND MEASURES Excellent or nonexcellent outcome at time of last follow-up. An excellent outcome was defined as Engel class I and a nonexcellent outcome as Engel classes II through IV.RESULTS Eighty-seven patients met inclusion criteria, with 48 (55%) achieving an excellent outcome following ATL. Unilateral IEDs on scalp EEG (P = .001) and complete resection of brain regions generating IEDs on baseline intraoperative ECoG (P = .02) were associated with excellent outcomes in univariate analysis. Both were associated with excellent outcomes when analyzed with Cox proportional hazards (unilateral-only IEDs, relative risk = 0.31 [95% CI, 0.16-0.64]; complete resection of IEDs on baseline ECoG, relative risk = 0.39 [95% CI, 0.20-0.76]). Overall, 25 of 35 patients (71%) with both unilateral-only IEDs and complete resection of baseline ECoG IEDs had an excellent outcome. CONCLUSIONS AND RELEVANCEUnilateral-only IEDs on preoperative scalp EEG and complete resection of IEDs on baseline ECoG are associated with better outcomes following standard ATL in magnetic resonance imaging-negative TLE. Prospective evaluation is needed to clarify the use of ECoG in tailoring temporal lobectomy.

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“…The semiology is variable, the epileptogenic zone is frequently broad and may coexist with hippocampal sclerosis ("dual pathology"), the interictal and ictal patterns multifocal, absent and occasional misleading and the imaging studies often unrevealing [8]. Most of the literature pertaining on the use of ECoG in extratemporal epilepsy stems from lesional cases [9][10][11][12], although prospective studies are lacking [13]. For non lesionalextratemporal resections the data is sparse [14].…”

Section: Discussionmentioning

confidence: 99%

Merging Tradition with Innovation: Intraoperative Corticography and 7 Tesla Magnetic Resonance Imaging Sparing Chronic Intracranial Electrode Implantation in "Non-Lesional" Epilepsy Surgery

Karakis¹,

Pathmanathan²

2011

J Neurol Neurophysiol

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Intra-operative electrocorticography in lesional epilepsy

Cited by 96 publications

References 49 publications

Epilepsy Surgery in a Pediatric Population: A Retrospective Study of 129 Children from a Tertiary Care Hospital in a Developing Country along with Assessment of Quality of Life

Epilepsy Surgery in a Pediatric Population: A Retrospective Study of 129 Children from a Tertiary Care Hospital in a Developing Country along with Assessment of Quality of Life

Interictal Scalp Electroencephalography and Intraoperative Electrocorticography in Magnetic Resonance Imaging–Negative Temporal Lobe Epilepsy Surgery

Merging Tradition with Innovation: Intraoperative Corticography and 7 Tesla Magnetic Resonance Imaging Sparing Chronic Intracranial Electrode Implantation in "Non-Lesional" Epilepsy Surgery

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