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Remifentanil-induced spike activity as a diagnostic tool in epilepsy surgery
L Grønlykke1, M L Knudsen, H Høgenhaven
1Deaprtment of Clinical Neurophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Objectives:
To assess the value of remifentanil in intraoperative evaluation of spike activity in patients undergoing surgery for mesial temporal lobe epilepsy (MTLE).
Materials And Methods:
Twenty-five patients undergoing temporal lobectomy for medically intractable MTLE were enrolled in the study. Electrocorticography (ECoG) recordings were performed on the intraventricular hippocampus and from the anterior inferior temporal and lateral neocortex before and after a 300 microg intravenous bolus of remifentanil. Spike activity was quantified as spike-count per minute.
Results:
A significant increase (P < 0.005) in spike activity was observed after administration of remifentanil in 23 of 25 patients (92%). Furthermore, two patients who did not have any spike activity on the baseline ECoG developed spikes after administration of remifentanil.
Conclusions:
The results suggest that remifentanil can enhance spike activity in the epileptogenic zone and reveal otherwise concealed epileptogenic tissue in patients with MTLE. Thus, remifentanil may prove to be an important diagnostic tool during surgical treatment for intractable focal epilepsy.
Insights
Remifentanil significantly increased spike activity in 92% of epilepsy patients, revealing hidden seizure zones. This suggests remifentanil is a valuable tool for intraoperative epilepsy surgery evaluation.
Area of Science:
- Neurosurgery
- Epileptology
- Pharmacology
Background:
- Mesial temporal lobe epilepsy (MTLE) is a common cause of intractable focal epilepsy.
- Surgical resection is a primary treatment for medically refractory MTLE.
- Accurate localization of the epileptogenic zone is crucial for successful surgical outcomes.
Purpose of the Study:
- To evaluate the utility of remifentanil in enhancing intraoperative electrocorticography (ECoG) for identifying spike activity in MTLE patients.
- To determine if remifentanil can unmask epileptogenic tissue not detected by baseline ECoG.
Main Methods:
- Twenty-five patients with medically intractable MTLE undergoing temporal lobectomy were studied.
- ECoG recordings were obtained from the hippocampus and neocortex before and after a 300 microg IV remifentanil bolus.
- Spike activity was quantified by counting spikes per minute.
Main Results:
- Remifentanil administration led to a significant increase in spike activity in 92% (23/25) of patients (P < 0.005).
- Two patients initially showing no spike activity developed spikes post-remifentanil administration.
- This indicates remifentanil's ability to enhance detection of epileptogenic activity.
Conclusions:
- Remifentanil effectively enhances spike activity within the epileptogenic zone in MTLE patients.
- The drug can reveal concealed epileptogenic tissue, improving localization accuracy.
- Remifentanil shows promise as a diagnostic aid in surgical treatment for intractable focal epilepsy.
