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Epileptiform and non-epileptiform paroxysmal activity from isolated cortex after functional hemispherectomy
R A Wennberg1, L F Quesney, J G Villemure
1Montreal Neurological Institute and Hospital, Quebec, Canada.
Summary
Acute complete cortical isolation after functional hemispherectomy (FH) consistently induced burst-suppression activity. Interictal epileptiform activity often persisted, suggesting isolation may lower the threshold for its expression.
Area of Science:
- Neuroscience
- Epileptology
- Surgical Neurology
Background:
- Functional hemispherectomy (FH) involves complete cortical isolation.
- Understanding the impact of cortical isolation on cerebral activity is crucial.
Purpose of the Study:
- To examine the relationship between acute complete cortical isolation and paroxysmal cerebral activity.
- To assess the persistence and changes in interictal epileptiform activity (EA) post-FH.
Main Methods:
- Electrocorticography (ECOG) was performed on 16 patients before and after FH.
- Systemic administration of propofol or methohexital was used to assess burst-suppression activity.
- Analysis of interictal epileptiform activity (EA) in isolated cortices.
Main Results:
- Burst-suppression activity was observed in all isolated cortices, intensified by anesthetics.
- Interictal epileptiform activity (EA) persisted in 11 cases and appeared in 2 cases post-FH.
- Cortical isolation may decrease the threshold for EA expression, independent of burst-suppression.
Conclusions:
- Acute complete cortical isolation leads to predictable burst-suppression activity.
- Functional hemispherectomy can alter the expression of interictal epileptiform activity.
- Cortical isolation's effect on EA threshold warrants further investigation.