Complications of Epilepsy Surgery

Polkey, Charles E.

doi:10.1002/9780470752463.ch71

Cited by 5 publications

(5 citation statements)

References 83 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous human studies showed that neurostimulation of the post-central gyrus frequently resulted in movement of the contralateral extremities [Nii et al, 1996; Fukuda et al, 2008], regardless of the age, the presence of dysplastic lesion, or seizure onset involving the frontal lobe [Haseeb et al, 2007]. Another human study suggested that resection of the post-central gyrus resulted in more pronounced deficits of the contralateral extremities compared to those after resection of the pre-central gyrus [Polkey, 2000]. Previous studies of healthy adults using transcranial magnetic stimulation (TMS) demonstrated that the TMS-related current flowing across the central sulcus not in an ‘anterior-to-posterior’ but a ‘posterior-to-anterior’ direction optimally activated the motor cortex [Brasil-Neto et al, 1992; Werhahn et al, 1994].…”

Section: Discussionmentioning

confidence: 99%

Cortical gamma‐oscillations modulated by auditory–motor tasks‐intracranial recording in patients with epilepsy

Nagasawa¹,

Robert²,

Juhász³

et al. 2010

Human Brain Mapping

View full text Add to dashboard Cite

SUMMARYHuman activities often involve hand-motor responses following external auditory-verbal commands. It has been believed that hand movements are predominantly driven by the contralateral primary sensorimotor cortex, whereas auditory-verbal information is processed in both superior temporal gyri. It remains unknown whether cortical activation in the superior temporal gyrus during an auditory-motor task is affected by laterality of hand-motor responses. Here, event-related gammaoscillations were intracranially recorded as quantitative measures of cortical activation; we determined how cortical structures were activated by auditory-cued movement using each hand in 15 patients with focal epilepsy. Auditory-verbal stimuli elicited augmentation of gamma-oscillations in a posterior portion of the superior temporal gyrus, whereas hand-motor responses elicited gammaaugmentation in the pre-and post-central gyri. The magnitudes of such gamma-augmentation in the superior temporal, pre-central and post-central gyri were significantly larger when the hand contralateral to the recorded hemisphere was required to be used for motor responses, compared to when the ipsilateral hand was. The superior temporal gyrus in each hemisphere might play a greater pivotal role when the contralateral hand needs to be used for motor responses, compared to when the ipsilateral hand does.

show abstract

Section: Discussionmentioning

confidence: 99%

Cortical gamma‐oscillations modulated by auditory–motor tasks‐intracranial recording in patients with epilepsy

Nagasawa¹,

Robert²,

Juhász³

et al. 2010

Human Brain Mapping

View full text Add to dashboard Cite

show abstract

“…The complication rates encountered are comparable to those of other reports showing permanent speech disturbances after temporal lobe surgery of between 0 and 5% (22,25,32). Polkey (33) estimated a risk of hemiparesis in <2% after temporal lobectomy. Behrens et al (22) reported an incidence of 1% of permanent hemiparesis after temporal resections.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Refractory Temporal Lobe Epilepsy in the Elderly: Seizure Outcome and Neuropsychological Sequels Compared with a Younger Cohort

Grivas¹,

Schramm²,

Kral³

et al. 2006

Epilepsia

128

114

View full text Add to dashboard Cite

Summary:Purpose: Surgical treatment of refractory temporal lobe epilepsy (TLE) is promising for selected patients, but only little experience has been acquired in operating on older patients, especially with limited resections. We intend to delineate clinical and surgical factors influencing outcome in patients older than 50 years at operation and to compare the results with those of a younger patient cohort.Methods: Fifty-two patients older than 50 years were operated on for intractable mesial or combined mesiolateral TLE between 1991 and 2002. The mean age at operation was 55 years, and the mean duration of epilepsy was 33 years. Forty selective amygdalohippocampectomies (33 for hippocampal sclerosis, seven for removal of a mesiotemporal lesion), five lateral temporal lesionectomies plus amygdalohippocampectomy, and seven anterior temporal lobectomies were performed. Eleven (21%) patients had undergone invasive presurgical video-EEG monitoring. The mean follow-up period was 33 months. We compared the results with those of a younger cohort operated on in the same time period.Results: Thirty-seven older patients attained complete seizure control (71% class I), and 10 patients had only rare postoperative seizures (19% class II). Four patients improved >75% (8% class III), and one patient did not improve (2% class IV). The same rate of seizure control was attained by 11 patients older than 60 years at surgery. These results were not significantly different from those in a younger patient group. A trend toward better seizure control was noted in 16 patients with an epilepsy duration of <30 years (all class I or II), and in 20 patients with a seizure frequency of fewer than five seizures per month (all class I or II). No mortality resulted from a total of 65 diagnostic and therapeutic procedures. A 3.8% permanent neurologic morbidity (dysphasia and hemiparesis) was noted. Hemianopia occurred in three (5.9%) patients. Neuropsychological testing revealed low preoperative performances and some gradual further deterioration after surgery.Conclusions: Results of surgery for TLE with mainly limited resections are promising in patients older than 50 years and older 60 years, despite the long seizure history. As expected, the risk of complications is somewhat higher compared with that in a younger control group. The impact of low neuropsychological performance is a concern.

show abstract

“…The inclusion criteria of the present study included: (i) age ranging from 5 months to 20 years, (ii) a two-stage epilepsy surgery using chronic subdural EEG recording in Children's Hospital of Michigan, Detroit between January 2001 and August 2006, (iii) functional cortical mapping for the primary hand motor area using electrical stimulation and (iv) subdural electrodes chronically implanted on both the pre-and post-central gyri at least 4 cm above the Sylvian fissure (Nii et al, 1996;Polkey, 2000). The exclusion criteria included: (i) the presence of massive brain malformations (such as large porencephaly, polymicrogyria or hemimegalencephaly) which is known to disorganize the anatomical landmarks for the central sulcus, (ii) history of previous epilepsy surgery, and (iii) the presence of epilepsia partialis continua involving the hand.…”

Section: Methods Patientsmentioning

confidence: 99%

“…A previous human study of epilepsy surgery in extratemporal lobe epilepsy suggested that surgical resection of the postcentral gyrus resulted in more pronounced deficits of the contralateral extremities compared to that after resection of the precentral gyrus (Polkey, 2000). Weakness of the contralateral hand associated with lesioning of the postcentral gyrus was attributed to loss of proprioception by the investigators (Polkey, 2000;Xerri et al, 1998).…”

Section: Evidence From Lesion Studiesmentioning

confidence: 98%

Young patients with focal seizures may have the primary motor area for the hand in the postcentral gyrus

Haseeb¹,

Asano²,

Juhász³

et al. 2007

Epilepsy Research

View full text Add to dashboard Cite

SummaryObjective: We determined whether the primary motor hand area was most frequently located in the precentral gyrus in young patients with intractable focal seizures. Methods:Sixty-five patients with focal seizures aged between 5 months and 20 years who underwent a two-stage epilepsy surgery using chronic subdural-EEG monitoring were studied. Pairs of subdural electrodes were electrically stimulated, and the brain region with contralateral hand movement induced by the lowest-intense stimulus was defined as the primary motor hand area.Results: Contralateral hand movement was induced without afterdischarges in 50 children but not in the remaining 15 children. The unpaired t-test revealed that failure to induce contralateral hand motor movement was associated with younger age of subjects. Among the 50 patients with a positive motor response, the primary motor hand area was confined to the precentral gyrus in 9 patients, confined to the postcentral gyrus in 24, and located in both the pre-and post-central gyri in the remaining 17. The McNemar's test revealed that the observed frequency of 24 patients showing the primary motor hand area confined to the postcentral gyrus was larger than chance frequency. Logistic regression analysis failed to demonstrate that the observation of the primary motor hand area confined to the postcentral gyrus was associated with the age, the presence of dysplastic lesion or the seizure onset involving the frontal lobe. Conclusion:Our study failed to support the traditionally-accepted notion that the primary motor hand area is most frequently located in the precentral gyrus but rather demonstrated that a substantial proportion of young patients had the primary motor hand area in the postcentral gyrus.

show abstract

Complications of Epilepsy Surgery

Cited by 5 publications

References 83 publications

Cortical gamma‐oscillations modulated by auditory–motor tasks‐intracranial recording in patients with epilepsy

Cortical gamma‐oscillations modulated by auditory–motor tasks‐intracranial recording in patients with epilepsy

Surgical Treatment for Refractory Temporal Lobe Epilepsy in the Elderly: Seizure Outcome and Neuropsychological Sequels Compared with a Younger Cohort

Young patients with focal seizures may have the primary motor area for the hand in the postcentral gyrus

Contact Info

Product

Resources

About