The combination of interictal and ictal MEG is a valuable tool for identification of the epileptogenic tuber/tubers in presurgical work-up in patients with TS.

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A reduction in spasticity due to SDR depends on the amount of cut roots. The functional result of SDR is affected not only by a decrease in spasticity but also by the functional status and age of the patient at the time of surgery. In all cases, laminoplasty should be performed to prevent spinal cord deformities.

Background: The purpose of this study was to evaluate the effectiveness of multiple hippocampal transections (MHT) in the treatment of drug-resistant mesial temporal lobe epilepsy. Methods: Six patients underwent MHT at Burdenko Neurosurgery Center in 2018. The age of the patients varied from 18 to 43 years. All patients suffered from refractory epilepsy caused by focal lesions of the mesial temporal complex or temporal pole in dominant side. Postoperative pathology revealed neuronal-glial tumors in two patients, focal cortical dysplasia (FCD) of the temporal pole – in two patients, cavernous angioma – in one patient, and encephalocele of the preuncal area – in one patient. Results: All patients underwent surgery satisfactorily. There were no postoperative complications except for homonymous superior quadrantanopia. This kind of visual field loss was noted in four cases out of six. During the follow-up period five patients out of six had Engel Class I outcome (83.3%). In one case, seizures developed after 1 month in a patient with FCD in the uncus (Engel IVA). After surgery, three out of six patients developed significant nominative aphasia. Two patients relative to the preoperative level demonstrated improvement in delayed verbal memory after MHT. Two patients showed a decrease level in delayed verbal memory. In preoperative period, visual memory was below the normal in one patient. Delayed visual memory in two cases impaired compared to the preoperative level. Conclusion: MHT can be considered as an effective method of drug-resistant mesial temporal lobe epilepsy caused by tumors of the medial temporal complex. At the same time, MHT makes it possible to preserve memory in patients with structurally preserved hippocampus. However, MHT do not guarantee the preservation of memory after surgery.

Aim. To reveal relation of change in intraoperative electroencephalography (EEG), electrocorticography (EсoG) with age of patients, the anamnesis duration, localization and type of pathology, the result of treatment.   Materials and methods. 64 patients with symptomatic epilepsy operated at N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of Russia from 2010 to 2016. 28 males, 36 females, age from 3 months to 18 years, on average 7,2 years. The pathology localization: temporal – 21 cases, occipital and parietal – 18, frontal – 25. Pathomorphology: 12 patients with focal cortical dysplasia (FCD) I, 20 patients with FCD II, 5 patients with FCD III, 4 patients with tuberous sclerosis, 20 patients with low grade tumors, and 3 cases else. The duration of diseaseis from 61 to 5081 days. Catamnesis (follow-up) ranged from 364 to 1877 days. There was four criteria for including patients in research: intraoperative EEG, presence of initial and control registration of EсoG, follow-up above 364 days. There are three hallmarks selected as significant concerning the efficiency of neurophysiological monitoring: 1) the positive changes in scalp EEG: decrease of interhemispheric asymmetry due to reduction of slow activity on the side of pathology; significant reduction of the unilateral epileptiform activity on the side of pathology and bilateral if exist; 2) the positive changes in EсoG: significant reduction of the regular epileptiform activity; 3) the absence or existence of residual epileptiform activity in adjacent to resected pathology sites. The statistical processing carried out with application of a Stat10 package.   Results. The more expressed positive dynamics of EEG were revealed in patients of smaller age already during operation. A correlation was found between the age of patients and the positive dynamics of intraoperative EEG. An inverse correlation was found between the duration of the disease and the positive dynamics of the scalp EEG during surgery (p = 0.1560). The EEG changes during surgery were shown more often with reduction of the seizure anamnesis. There was found out that residual epileptiform activity on ECoG occurred more often at patients with longer anamnesis of a disease and at patients with frontal localization of pathology. The residual epileptiform activity on ECoG was registered more often at patients with preservation of seizures (outcomes 2, 3, 4, 5 ILAE).   Conclusions. During resective interventions for symptomatic epilepsy in children the probability of positive changes was the more, the younger the patient was. Intraoperative ECoG is one of the useful tools in epilepsy surgery, but it does not definitely determine success. There was no statistically significant relationship between the presence of residual epileptiform signs on the ECoG in the cortex adjacent to the removal area and the outcome of surgical treatment for seizures. Patients in follow-up had three times fewer seizures in the absence of residual epileptiform activity on the ECoG of adjacent to the resected areas of the cortex. The dependence is statistically insignificant. Removal of FCD type III and tumors is accompanied by a more complete elimination of epileptiform activity than FCD I, the level of statistical significance of p = 0.0305.

По разным данным [1], около 40% детей с фар-макорезистентной симптоматической эпилепсией имеют пороки развития коры головного мозга. При хирургическом лечении эпилепсии у детей в первые 2 года жизни выявляемость кортикальных диспла-зий достигает 70% [2]. Цель исследования -определение значимых различий электрокортикографических паттернов при различных типах фокальных корковых дисплазий. Материал и методы. 42 пациента с диагнозом «фармакорезистентная фокальная эпилеп-сия» прооперированы с 2006 по 2013 г. в НИИ нейрохирургии им. акад. Н.Н. Бурденко. Рассматривались пациенты, которым гистологически был установлен диагноз «фокальная кортикальная дисплазия» и были проведены видеоэлектро-энцефалография и электрокортикография. Результаты. Использовалась классификация эпилептиформных паттернов, предложенная Palmini в 1995 г. В электрокортикографических исследованиях преобладал паттерн спорадической эпилеп-тиформной активности. Продолженный паттерн встречался чаще при II типе фокальных кортикальных дисплазий (ФКД) как в комбинациях, так и изолированно; паттерны вспышек и спорадической активности преобладали в комбинациях при III типе ФКД. При I типе ФКД отмечалось равномерное распределение всех типов паттернов эпилептиформной активно-сти. Для групп с наличием спорадического и продолженного паттернов данные статистически достоверны. Заключение. При II типе фокальных кортикальных дисплазий преобладает паттерн продолженной эпилептиформной активности, что соответствует наиболее выраженным процессам эпилептогенеза ткани головного мозга c наличием патологических форм нейронов. При I типе ФКД отмечается равномерное распределение паттернов. При III типе ФКД преобладают паттерны спорадической эпилептиформной активности и вспышек спайков. Спорадическая активность, вероятно, является неспе-цифической и практически равномерно распределяется при всех типах кортикальных дисплазий. Objective -the objective of the study was to determine significant differences in electrocorticographic patterns for various types of focal cortical dysplasias. Material and methods. 42 patients diagnosed with drug-resistant focal epilepsy were operated on at the Burdenko Neurosurgical Institute in the period from 2006 to 2013. Patients who were histologically diagnosed with focal cortical dysplasia (FCD) and underwent video-electroencephalography and electrocorticography were analyzed. Results. The classification of epileptiform patterns proposed by Palmini in 1995 was used. The sporadic epileptiform activity pattern was predominant in electrocorticographic studies. The continued pattern was more frequent in the case of type II focal cortical dysplasias (FCDs), both combined and isolated; burst and sporadic activity patterns prevailed in combinations in the case of type III FCDs. A uniform distribution of all pattern types of the epileptiform activity was observed in type I FCDs. The data are statistically significant for groups with sporadic and continued patterns. Conclusion. The continued epileptiform activity pattern is predominant in type II focal cort...