Clinical Applications of Studies on Stereotactically Implanted Electrodes in Temporal-Lobe Epilepsy

Abstract

HE clinical manifestations of discharges of seizures now termed temporal-lobe epilepsy, have been recognized since the article of Jackson TM in 1888. That the origin is in the uncinate region was reported by Jackson and Cohnan 1~ in 1898. The development of electroencephalography was necessary to provide a confirmatory test and a reliable means to distinguish these states of seizures. Jasper and Kershman 12 observed in 1941 that patients with psychomotor episodes usually had sharp waves and rhythms of 6 per sec., often synchronous bilaterally, and sometimes localized in the frontotemporal regions. It seemed clear to them from the nature of these disturbances that the temporal lobe and subjacent structures in the archipallium were the regions involved primarily. The first clear correlation of the clinical features and the loci of anteriortemporal spikes either unilaterally or bilaterally, as well as their detection by recording during sleep, came from Gibbs et al. 6 in 1948. With the identification of states of focal seizures in the temporal regions some afflicted patients who were not relieved by anticonvulsant medication were given surgical therapy by Penfield and Flanigin TM in 1950 and by Bailey and Gibbs 3 in 1951. Subsequent long-term follow-up studies and confirmation of similar results by numerous other surgeons 2,4,7-9,i6,19 have established this method of treatment for clearly focal temporal epilepsy. The consensus of results is that at least two-thirds of patients have complete or very good relief from seizures

The Place of Stereotactic Depth Electrode Recording in Epilepsy

“…These patients who had been rejected for surgery in the past [1,2] will show, following a temporal lobectomy, a decrease in their seizure tendency comparable with the so-called 'unila teral' cases [2,5]. Another indication for this procedure is the persist ence of ambiguity in the localization within one hemisphere where there is a clear hemispheric lateralization.…”

Intracranial depth electrodes implantation in the era of image-guided surgery

“…Stereotactic implantation of intracranial electrodes gained popularity and was mentioned as part of the evaluation of temporal lobe epilepsy at the beginning of the 1960s 19 . Meanwhile, in the Neurosurgical Unit of Hospital Saint-Anne, in Paris, stereotactic investigations using intracranial electrodes in epileptic patients were inspired by a recently elaborated new concept: epileptic seizures were considered to be a dynamic process with temporal-spatial organization that was sometimes multidirectional and could be better defined as a three-dimensional arrangement [20][21][22][23] .…”

Estereoeletroencefalografia na era da cirurgia guiada por imagem

“…18 A implantação estereotáxica de eletrodos intracranianos ganhou popularidade e foi mencionada como parte da avaliação da epilepsia do lobo temporal no início dos anos 60. 19 Enquanto isso, na Unidade Neurocirúrgica do Hospital Saint-Anne, em Paris, as investigações estereotáxicas com eletrodos intracranianos em pacientes epiléticos estava inspirada em um novo conceito recentemente elaborado: as crises epiléticas eram consideradas um processo dinâmico com uma organização temporo-espacial, às vezes multidirecional, podendo ser mais bem definida como um arranjo tridimensional. [20][21][22][23] O local de origem e da organização primária deste processo dinâmico em epilepsias focais, cuja remoção cirúrgica resultaria no controle das crises, foi definido como a ZE Com essas premissas, o grupo de Saint-Anne desenvolveu a metodologia da E-EEG, 24,25 que permitia alcançar as complexas exigências de definir no espaço tridimensional e no tempo, a organização das descargas ictais.…”