Comparison of the effects of different anesthetic techniques on electrocorticography in patients undergoing epilepsy surgery – A bispectral index guided study

Bindra, Ashish; Chouhan, Rajendra Singh; Prabhakar, Hemanshu; Dash, Hari H.; Chandra, P. Sarat; Tripathi, Manjari

doi:10.1016/j.seizure.2012.05.002

Cited by 19 publications

(23 citation statements)

References 25 publications

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“…Despite its widespread usage, there are still controversies regarding its utility especially keeping in mind its short period of application. [27282930] It also should be kept in mind that any electrode used potentially records from millions of neurons, for example, a circular electrode of the EcoG grid sits over 10 6 neurons, each having about 10 4 connections. Thus, this is equivalent to hanging a microphone among a population of 1 million people, each talking to 10,000 persons!…”

Section: Tools To Study Epileptogenic Networkmentioning

confidence: 99%

Epileptogenic networks and drug-resistant epilepsy: Present and future perspectives of epilepsy research-Utility for the epileptologist and the epilepsy surgeon

Banerjee¹,

Chandra²,

Kurwale³

et al. 2014

Ann Indian Acad Neurol

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A multidisciplinary approach is required to understand the complex intricacies of drug-resistant epilepsy (DRE). A challenge that neurosurgeons across the world face is accurate localization of epileptogenic zone. A significant number of patients who have undergone resective brain surgery for epilepsy still continue to have seizures. The reason behind this therapy resistance still eludes us. Thus to develop a cure for the difficult to treat epilepsy, we need to comprehensively study epileptogenesis. Till date, most of the studies on DRE is focused on undermining the abnormal functioning of receptors involved in synaptic transmission and reduced levels of antiepileptic drugs around there targets. But recent advances in imaging and electrophysiological techniques have suggested the role epileptogenic networks in the process of epileptogenesis. According to this hypothesis, the local neurons recruit distant neurons through complex oscillatory circuits, which further recruit more distant neurons, thereby generating a hypersynchronus neuronal activity. The epileptogenic networks may be confined to the lesion or could propagate to distant focus. The success of surgery depends on the precision by which the epileptogenic network is determined while planning a surgical intervention. Here, we summarize various modalities of electrophysiological and imaging techniques to determine the functionally active epileptogenic networks. We also review evidence pertaining to the proposed role of epileptogenic network in abnormal synaptic transmission which is one of the major causes of epileptiform activity. Elucidation of current concepts in regulation of synaptic transmission by networks will help develop therapies for epilepsy cases that cannot be managed pharmacologically.

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Section: Tools To Study Epileptogenic Networkmentioning

confidence: 99%

Epileptogenic networks and drug-resistant epilepsy: Present and future perspectives of epilepsy research-Utility for the epileptologist and the epilepsy surgeon

Banerjee¹,

Chandra²,

Kurwale³

et al. 2014

Ann Indian Acad Neurol

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“…Added to the above, they showed that the addition of N 2 O reduced the epileptiform activity in the iECoG. 13 Another study, which included propofol-remifentanil or sevofluraneremifentanil groups, did not find any differences between groups in spike frequency, spike amplitude, or number of spiking leads. Decreasing BIS levels in both groups enhanced epileptogenic spike frequency and amplitude with the same location and number of spiking leads.…”

Section: Discussionmentioning

confidence: 99%

“…12 It is measured in a score from 0 to 100 based on an algorithm empirically calculated based on changes observed in the EEG pattern during general anesthesia; a score between 40 and 60 correlates with a low probability of intraoperative awareness. 11,13 It has been proposed that the BIS may be used to titrate volatile anesthetics more precisely to individual requirements. The aforementioned avoids exposure to unnecessarily high concentrations of anesthetics while minimizing the likelihood of awareness during anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Correlation Between Bispectral Index and Electrocorticographic Features During Epilepsy Surgery

et al. 2016

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Surgical resection guided by intraoperative electrocorticography (iECoG) has been in clinical use for many decades. The use of the bispectral index (BIS) for monitoring depth of anesthesia during different types of surgery, including epilepsy surgery, is increasing nowadays. The BIS is an EEG-derived variable indicating cortical electrical activity. However, the correlation between the BIS score and the iECoG score, with the purpose of optimizing the quality and time of the iECoG recordings in epilepsy surgery is unknown. The goal of this study was to evaluate the correlation between BIS values and iECoG parameters during the epilepsy surgery under anesthesia with propofol and fentanyl. This is a prospective study that included patients with epilepsy who underwent epilepsy surgery guided by BIS and iECoG (September 2008 to October 2013). Clinical, physiological, and sociodemographic characteristics are shown. We correlated the iECoG parameters (presence of burst suppressions [BS], suppression time [seconds], background frequency [Hz], and type of iECoG score by Mathern et al) with BIS values. We included 28 patients, 15/28 (53.5%) female, general mean age of 30.5 years (range 13-56 years). Patients underwent epilepsy surgery: 22/28 (79%) temporal and 6/28 (21%) extratemporal. We found a nonlinear polynomial cubic relationship between the mentioned variables noting that a BIS range of 40 to 60 gave the following results: iECoG BS periods <5 seconds, background frequency 10 to 17 Hz, and iECoG score 2 characterized by lack of >20-Hz background frequencies. No BS were observed with a BIS > 60. In conclusion BIS values and iECoG parameters during the epilepsy surgery under anesthesia with propofol and fentanyl have a nonlinear correlation. BS patterns were not found with a BIS > 60. These findings show that BIS is a nonlinear multidimensional measure, which possesses high variability with the iECoG parameters. BS patterns are not found with BIS > 60.

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“…During epilepsy surgery, monitoring the subdural electrocorticogram (ECoG) is a common procedure used to identify the location and the extent of epileptogenic zone, as well as to guide the extent of resection. As anesthetics influence ECoG in patients with epilepsy , the choice of anesthetics that do not suppress epileptiform discharges is important to determine the area of resection. Although general anesthetic techniques for epilepsy surgery remain largely empiric, typically institution‐specific and sparsely described in literature, sevoflurane is one of the anesthetics used for this purpose .…”

Section: Introductionmentioning

confidence: 99%

“…Surgical intervention in a pediatric population leads to improved outcomes ; however, few studies have examined the effect of general anesthesia on ECoG in pediatric patients with epilepsy . As sevoflurane induces epileptic discharge in children as well as in adults , it is important to elucidate the effect of inhalational anesthetics on ECoG in children.…”

Section: Introductionmentioning

confidence: 99%

The effect of sevoflurane on electrocorticographic spike activity in pediatric patients with epilepsy

Tanaka

Oda

Ryokai

et al. 2017

Pediatric Anesthesia

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Comparison of the effects of different anesthetic techniques on electrocorticography in patients undergoing epilepsy surgery – A bispectral index guided study

Abstract: In our study optimal ECoG recordings were possible with use of either isoflurane or propofol. Addition of nitrous oxide to either of the anesthetic regimens suppressed the ECoG score.

Cited by 19 publications

References 25 publications

Epileptogenic networks and drug-resistant epilepsy: Present and future perspectives of epilepsy research-Utility for the epileptologist and the epilepsy surgeon

Epileptogenic networks and drug-resistant epilepsy: Present and future perspectives of epilepsy research-Utility for the epileptologist and the epilepsy surgeon

Correlation Between Bispectral Index and Electrocorticographic Features During Epilepsy Surgery

The effect of sevoflurane on electrocorticographic spike activity in pediatric patients with epilepsy

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