Pure bipolar electro-coagulation on functional cortex in the treatment of epilepsy involving eloquent areas

Although resection of an epileptogenic region remains the main procedure of epilepsy surgery, epileptogenic areas in functionally critical cortex cannot be approached in that manner. Bipolar electro-coagulation on functional cortex (BCFC) was developed to treat such refractory seizures without causing unacceptable neurological deficits. Here we report the outcome of this therapy.

Fifteen patients who underwent pure BCFC without resection between 2002 and 2008 were retrospectively reviewed with regard to seizure outcome, postoperative complications, and predictive factors.

Seven patients developed hemiparesis after the operation but fully recovered within 1-6 months. One patient developed mild dysphasia, which was resolved within 12 months. All neurological deficits were temporary in the sense that they ultimately did not result in a deficit that would be noticed during a standard clinical examination. There were no subdural hemorrhage and infection. Engel class I outcome was achieved in two (13.3%) patients; class II, in six (40%); class III, in three (20%); and class IV, in four (26.7%).

The BCFC technique is only a palliative surgery, and cannot be applied for all epilepsies, however, this therapy proved to be effective when the epileptogenic foci are located in unresectable cortex. BCFC is safe and easy to use.