Comparison of Scalp Electroencephalogram With Subdural Electrocorticogram Recordings and Functional Mapping in Frontal Lobe Epilepsy

Salanova, Vicenta; Morris, Harold H.; Ness, Paul C. Van; Lüders, Hans

doi:10.1001/archneur.1993.00540030058015

Cited by 69 publications

(48 citation statements)

References 25 publications

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“…Numerous independent factors have been analyzed, and the best results for long-term postoperative seizure relief occur in patients with intracranial lesions, assuming resections are complete (4,10,(14)(15)(16)(17)(18)(19)(20). However, the epileptogenic zone may not be completely congruent with the lesion, differing both in size or even location (21,22).…”

Section: Discussionmentioning

confidence: 99%

“…For eight patients, the earliest ictal manifestations consisted of repetitive spikes; one patient in this group became seizure free, four patients demonstrated a worthwhile improvement, and three did not significantly improve. In six patients, the earliest ictal changes consisted of rhythmic activity in alpha to low beta range (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), three patients in this group became seizure free, one had worthwhile improvement, and two did not improve. The last group (four patients) was represented by pattern of rhythmic slow waves or spike-and-wave complexes; two patients in this group had seizure-free outcomes, and two other patients significantly improved.…”

Section: Morphology Of Ictal Patternmentioning

confidence: 99%

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Ictal Patterns of Neocortical Seizures Monitored with Intracranial Electrodes: Correlation with Surgical Outcome

1999

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Summary:Purpose: Numerous factors have been analyzed in attempts to predict the outcome of surgical resections in patients with neocortical epilepsy. We examined the correlation between surgical outcome and electrocorticographic features of neocortical ictal patterns.Methods: Twenty six patients with neocortical epilepsy underwent monitoring with subdural grid electrodes before surgery. Ictal patterns were analyzed retrospectively and correlated with three types of outcome: seizure free, worthwhile improvement (>75% reduction of seizure frequency), and no worthwhile improvement. The duration of follow-up was 2-5 years.Results: lctal patterns were divided according to the size of epileptogenic zone (focal, regional, multifocal); velocity and type of seizure propagation (fast contiguous, slow contiguous, noncontiguous); pattern of the onset of ictal activity; part of the cortex involved in the origin of the seizure (frontal, frontocentroparietal, etc.). Spread to medial temporal structures (as assessed by subtemporal strips) also was evaluated in selected cases. Statistically significant correlation with surgical outcome (p = 0.026) was shown for only one variable: type of spread. Patients with slow spread (n = 8) demonstrated the best outcomes (five are seizure free), whereas patients with noncontiguous spread (n = 5 ) demonstrated the worst outcomes (four did not improve significantly). Patients with fast contiguous spread (n = 13) showed intermediate outcomes.Conclusions: Types of propagation of ictal neocortical activity correlate with surgical outcome. Analysis of ictal pattern during intracranial recordings may help to predict surgical outcome for neocortical epilepsy. Key Words: Ictal patternSeizure spread-Epileptogenic zone.Neocortical epilepsy presents a substantial problem from both medical and surgical perspectives. Medical management of neocortical epilepsy is difficult because of notoriously poor response to anticonvulsant medications (AEDs) and disconcertingly high frequency of seizures (1-3). Surgical management is challenging because of the elusive nature of ictal onset, which frequently requires intracranial monitoring ( 4 3 , and the frequently encountered dilemma of separating resectable epileptogenic regions from vital eloquent cortex (6).The outcome of epilepsy surgery for different types of neocortical epilepsy is substantially worse than that for medial temporal epilepsy. The variability in the seizurefree outcome rate is striking, ranging from 10% for selected posterior temporal, temporoparietal, and occipital cases (7) to 26% in a large retrospective review of Montreal Neurological Institute surgical cases (S), 43% in a combined multicenter study (9) to 53.7% in retrospective analysis performed at the Institute of Neurosurgery,

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Section: Discussionmentioning

confidence: 99%

Section: Morphology Of Ictal Patternmentioning

confidence: 99%

Ictal Patterns of Neocortical Seizures Monitored with Intracranial Electrodes: Correlation with Surgical Outcome

1999

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“…Based on SPECT findings, the responsible lesion for the focal epilepsy was considered to be in the left inferior frontal cortex, as cerebral blood flow at the focus of epilepsy increases during the ictal period and decreases during the interictal period (Duncan, 1997). Surface EEG revealed no interictal epileptiform discharges, suggesting that the responsible lesion for frontal lobe epilepsy was located in a small or deep area in the frontal lobe (Salanova et al, 1993;Kellinghaus and Lüders, 2004). It is also possible that the antiepileptic drug may have masked the epileptiform discharges.…”

Section: Discussionmentioning

confidence: 99%

Steroid-responsive focal epilepsy with focal dystonia accompanied by glutamate receptor delta2 antibody

Matsumoto

Okabe²,

Hirakawa-Yamada³

et al. 2012

Journal of Neuroimmunology

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“…for a child with infantile spasms), the general region which needs to be resected may be reasonably clear after the noninvasive evaluation, but the precise limits will be defined in the operating room based on location of interictal spike discharges, differences in background EEG patterns, identification of important functional cortex (e.g. primary motor-sensory cortex) using intraoperative somatosensory evoked potentials, and anatomic constraints [72, 75]. …”

Section: Preoperative Localization Of Seizure Onsetmentioning

confidence: 99%

Evaluation of Children for Epilepsy Surgery

Olson

2001

Pediatr Neurosurg

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There are three main components to the evaluation of children who are candidates for epilepsy surgery: (1) confirmation of the epileptic nature of the seizures, (2) establishing the medical intractability of the child’s epilepsy and (3) localization of the epileptogenic zone. Differentiating epileptic from nonepileptic events requires careful review of the history and the electroencephalogram. Electroencephalographic recording of the habitual seizures usually suffices to confirm the epileptic or nonepileptic nature of the events. Medical intractability is established by assuring that antiepileptic medications appropriate for the child’s particular epilepsy syndrome have been used and have been titrated to maximum tolerance before being deemed ineffective. Confident localization of the epileptogenic zone requires that multiple findings such as behavior during the seizure, ictal and interictal EEG, and cerebral imaging studies provide data that are convergent with respect to a likely area of seizure onset.

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Comparison of Scalp Electroencephalogram With Subdural Electrocorticogram Recordings and Functional Mapping in Frontal Lobe Epilepsy

Cited by 69 publications

References 25 publications

Ictal Patterns of Neocortical Seizures Monitored with Intracranial Electrodes: Correlation with Surgical Outcome

Ictal Patterns of Neocortical Seizures Monitored with Intracranial Electrodes: Correlation with Surgical Outcome

Steroid-responsive focal epilepsy with focal dystonia accompanied by glutamate receptor delta2 antibody

Evaluation of Children for Epilepsy Surgery

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