Cortical motor mapping in epilepsy patients: information from subdural electrodes in presurgical evaluation

It is essential to delineate an epileptogenic zone and to define the eloquent cortices at or close to the epileptogenic zone in patients with neocortical epilepsy for epilepsy surgery. Prolonged implantation of the subdural electrode in presurgical evaluation is currently one of the best clinical methods to provide the essential information before epilepsy surgery. Electric cortical stimulation and recording of sensory evoked potentials by means of subdural electrodes are widely used for functional cortical mapping. Bereitschaftspotential (BP) is clinically useful to delineate the primary and nonprimary motor cortices such as supplementary motor area proper (SMA proper) and pre-SMA, because BP occurs for any type of voluntary movements of the body, and because it is not associated with the risk of seizure induction in contrast with high-frequency cortical electric stimulation. Single-pulse electric cortical stimulation to record motor evoked potentials (MEPs) also could complement currently used high-frequency cortical electric stimulation, especially for mapping of the primary motor and premotor cortices with lower risk of seizure induction.