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Predictive value of intraoperative electrocorticograms in resective epilepsy surgery
M C McBride1, C D Binnie, I Janota
1Maudsley Hospital, London, England.
Annals of Neurology
|October 1, 1991
Summary
Intraoperative electrocorticograms in epilepsy surgery show discharge rate and persistence of epileptiform activity predict seizure control. High discharge rates and low persistence correlate with good outcomes, while low rates and high persistence suggest poor seizure control.
Area of Science:
- Neurosurgery
- Epileptology
- Clinical Neurophysiology
Background:
- Intractable epilepsy often requires surgical intervention.
- Intraoperative electrocorticography (iECoG) is used during epilepsy surgery.
- Predicting surgical outcomes remains a challenge.
Purpose of the Study:
- To analyze iECoG parameters in relation to pathology and seizure control.
- To determine if epileptiform activity characteristics predict surgical success.
Main Methods:
- Analysis of preresection and postresection iECoGs from 76 epilepsy patients.
- Correlation of epileptiform activity (location, rate, configuration) with resected pathology.
- Assessment of seizure outcome post-resective surgery.
Main Results:
- Spike focus location did not correlate with pathology or outcome in temporal lobe surgery.
- Fast repetitive spikes in amygdala/hippocampus associated with mesiotemporal pathology.
- Low preresection discharge rates (<1/4 min) predicted poor outcomes.
- High discharge rates (>18/min) predicted good outcomes.
- Persistence of ≥50% preresection activity post-surgery correlated with poor outcomes.
Conclusions:
- Discharge rate and persistence of epileptiform activity on iECoG are significant predictors of seizure control.
- Further research is needed to fully define the role of iECoG in epilepsy surgery outcomes.