Methohexital activation of epileptogenic foci during acute electrocorticography

Methohexital was used as an activating agent in 62 patients undergoing focal cortical resections of epileptogenic foci and in six patients undergoing chronic electroencephalogram (EEG)/video monitoring with intracranial strip electrodes. In 87% of cases, methohexital caused selective activation of the epileptogenic focus during acute electrocorticography (ECoG). This activation appeared to be specific for the epileptogenic focus and did not cause epileptiform spiking from adjacent nonepileptogenic cortex. This ECoG activation occurred whether patients received local or general anesthesia. Sixty-five percent of patients demonstrated adequate activation with as little as 25 mg of drug. Methohexital is a safe and reliable method of activating epileptogenic foci during acute ECoG recordings and can decrease the time for ECoG recordings during surgery.