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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early years,...

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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Bipolar electrocoagulation on cortex after AVMs lesionectomy for seizure control.

Yong Cao1, Rong Wang, Lijun Yang

  • 1Department of Neurosurgery, Beijing Tiantan Hospital, China.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|December 16, 2010
PubMed
Summary

Additional bipolar electrocoagulation guided by electrocorticography (ECoG) effectively controls seizures in patients with cerebral arteriovenous malformations (AVMs). This technique improves seizure outcomes after AVM surgical excision, offering a valuable addition to current epilepsy management strategies.

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Neurology

Background:

  • Management of seizures following cerebral arteriovenous malformation (AVM) surgical excision remains controversial.
  • Intraoperative electrocorticography (ECoG) can identify epileptogenic zones.
  • The efficacy of adjunctive bipolar electrocoagulation guided by ECoG for seizure control in AVM patients is evaluated.

Purpose of the Study:

  • To assess the effectiveness of additional bipolar electrocoagulation on the electrically positive cortex, guided by intraoperative ECoG, for controlling epilepsy related to cerebral AVMs.
  • To determine seizure outcomes and complications after surgical excision of AVMs with adjunctive electrocoagulation.

Main Methods:

  • Sixty patients with seizures due to cerebral AVMs underwent surgical excision and intraoperative ECoG.
  • Complete removal of AVMs and surrounding hemosiderin-stained tissue was performed.
  • Bipolar electrocoagulation was applied to the cortex showing epileptic discharges on ECoG; patients were followed up for seizure outcomes using Engel's classification.

Main Results:

  • Epileptic discharges were detected in 81.6% of patients before and after AVM excision.
  • Following electrocoagulation, epileptic discharges disappeared in 45 patients and diminished in four.
  • At a mean follow-up of 51.1 months, 70.9% of patients achieved Engel Class I seizure outcome.

Conclusions:

  • Residual epileptic spikes on the cerebral cortex surrounding completely removed AVMs are common.
  • Additional bipolar electrocoagulation guided by intraoperative ECoG is effective in achieving surgical seizure control.
  • This technique represents a valuable strategy for managing cerebral AVM-related epilepsy.