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Running-down phenomenon captured with chronic electrocorticography.

Aaron S Geller1, Daniel Friedman1, May Fang2

  • 1Department of Neurology NYU School of Medicine New York New York U.S.A.

Epilepsia Open
|December 8, 2018
PubMed
Summary
This summary is machine-generated.

The electrographic running-down phenomenon, a decrease in seizure activity, was detailed in a patient using chronic electrocorticography (ECoG) after epilepsy surgery. This observation provides new insights into seizure focus deactivation post-intervention.

Keywords:
ElectrocorticographyResponsive neurostimulationRunning‐down phenomenon

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Area of Science:

  • Neuroscience
  • Epileptology
  • Surgical Neurology

Background:

  • The running-down phenomenon describes seizure reduction post-epilepsy surgery, with clinical and electrographic forms.
  • The electrographic form, a decrease in seizure focus activity, is rarely documented, typically using scalp EEG.
  • Understanding this phenomenon is crucial for evaluating surgical outcomes and developing new epilepsy treatments.

Purpose of the Study:

  • To present a detailed human case of the electrographic running-down phenomenon using chronic electrocorticography (ECoG).
  • To investigate the deactivation of a secondary seizure focus after partial resection of the primary epileptogenic zone.

Main Methods:

  • Chronic ECoG monitoring via a responsive neurostimulator (RNS System) in a patient with a left temporal seizure focus.
  • Automated spike detection and review of electrographic episodes recorded by the RNS System.
  • Analysis of seizure activity and epileptiform discharges over time post-surgery.

Main Results:

  • The patient remained seizure-free for over two years post-surgery despite a limited resection.
  • ECoG recordings showed a progressive diminution in spiking and rhythmic discharges.
  • These findings are consistent with the electrographic running-down phenomenon, indicating deactivation of residual epileptogenic tissue.

Conclusions:

  • Chronic ECoG provides unprecedented detail for observing the electrographic running-down phenomenon in humans.
  • The study supports the concept of secondary epileptogenesis reversal and deactivation of seizure foci.
  • This detailed demonstration aids in understanding post-surgical seizure dynamics and the potential of neurostimulation monitoring.