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Post-resection electrocorticography has no added value in epilepsy surgery.

Riëm El Tahry1, Susana Ferrao Santos2, Marianne de Tourtchaninoff2

  • 1Department of Neurology, Center for Refractory Epilepsy, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium. riem.eltahry@uclouvain.be.

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|April 21, 2016
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Summary

Tailored epilepsy surgery guided by intra-operative electrocorticography (ECoG) did not improve outcomes in patients with lesional or non-lesional epilepsy. Persistent interictal epileptiform discharges (IED) after surgery also did not correlate with poorer seizure control.

Keywords:
ElectrocorticographyEpilepsy surgeryRefractory epilepsy

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Clinical Neuroscience

Background:

  • Intra-operative electrocorticography (ECoG) is crucial for identifying the epileptogenic zone in epilepsy surgery.
  • Tailoring surgery based on ECoG findings is a potential strategy to improve patient outcomes.

Purpose of the Study:

  • To evaluate if epilepsy surgery guided by intra-operative post-resection electrocorticography (ECoG) improves outcomes.
  • To assess the correlation between residual interictal epileptiform discharges (IED) and surgical outcomes.

Main Methods:

  • Retrospective review of 94 epilepsy surgery cases utilizing intra-operative ECoG.
  • Analysis of ECoG-guided surgical modifications and presence of specific interictal epileptiform discharge (IED) patterns.
  • Correlation of postoperative outcomes with ECoG findings and surgical tailoring.

Main Results:

  • ECoG-guided surgical tailoring did not lead to improved outcomes in either lesional or non-lesional epilepsy.
  • The presence of postoperative residual interictal epileptiform discharges (IED) on ECoG did not correlate with poorer surgical outcomes.
  • Specific recurrent ECoG patterns of interictal epileptiform discharges (IED) were analyzed.

Conclusions:

  • Intra-operative post-resection ECoG-guided surgical tailoring does not enhance outcomes for medically refractory partial epilepsies.
  • The persistence of interictal epileptiform discharges (IED) on postoperative ECoG is not a reliable predictor of poor surgical outcomes in lesional or non-lesional epilepsy.