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Do reactive post-resection "injury" spikes exist?

T H Schwartz1, C W Bazil, M Forgione

  • 1Departments of Neurological Surgery and Neurology, The Neurological Institute, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.

Epilepsia
|November 15, 2000
PubMed
Summary
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New post-resection spikes on electrocorticography (ECoG) after brain surgery may be reactive, not residual tumor. These injury spikes in patients without prior seizures do not predict future seizures.

Area of Science:

  • Neurosurgery
  • Neurophysiology
  • Epileptology

Background:

  • Post-resection electrocorticography (ECoG) spikes in patients with epilepsy can indicate residual epileptogenic tissue.
  • Distinguishing between residual tissue and reactive injury spikes is crucial for accurate patient management.

Purpose of the Study:

  • To investigate whether post-resection spikes following lesionectomy are indicative of reactive injury.
  • To differentiate injury spikes from residual epileptogenic tissue in patients undergoing tumor resection.

Main Methods:

  • Electrocorticography (ECoG) was performed before and after gross-total resection of intra-axial neocortical tumors in seven patients.
  • Patients selected had no history of seizures, eliminating pre-existing epileptogenic activity as a cause for spikes.

Related Experiment Videos

Main Results:

  • Two patients exhibited new post-resection spikes (average rate: 4 spikes/min) despite normal preoperative ECoG.
  • Pre-existing spikes in two other patients resolved after surgery.
  • Neither patient who developed new post-resection spikes subsequently experienced seizures.

Conclusions:

  • Surgical irritation of the neocortex can cause reactive epileptogenic discharges after tumor resection.
  • These injury spikes occur at a slow rate and are not predictive of clinical seizures.
  • Post-resection spikes in this context likely represent a benign reactive phenomenon rather than residual tumor.