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Pharmacological activation
1Division of Epilepsy, Mayo Clinic, Mayo Medical School, Rochester, MN, USA.
Electroencephalography and Clinical Neurophysiology. Supplement
|February 9, 1999
Summary
Pharmacologic activation plays a minor role in epilepsy surgery, with preoperative evaluations being crucial. While electrocorticography (ECoG) is valuable, drug-induced discharges should not replace spontaneous ones during ECoG monitoring.
Area of Science:
- Neurosurgery
- Epileptology
- Clinical Neurophysiology
Background:
- Intractable partial epilepsy requires precise surgical treatment.
- Electrocorticography (ECoG) is used to delineate seizure foci.
- The role of pharmacologic activation during ECoG is debated.
Purpose of the Study:
- To evaluate the utility of pharmacologic activation during ECoG in epilepsy surgery.
- To determine the importance of pharmacologic activation versus spontaneous discharges.
Main Methods:
- Review of clinical studies and existing data on pharmacologic activation during ECoG.
- Analysis of the role of preoperative evaluations (EEG, MRI) in surgical planning.
- Consideration of specific drugs like methohexital for activation.
Main Results:
- Pharmacologic activation has a minor role in determining cortical excision limits.
- Extensive preoperative evaluations (long-term EEG, MRI) are of primary importance.
- Spontaneous epileptiform discharges are preferred over drug-induced ones during ECoG.
Conclusions:
- ECoG's continued use is justified by its putative beneficial effects.
- Pharmacologic activation may be considered only if spontaneous discharges are absent during pre-excision ECoG.
- Post-excision ECoG with pharmacologic activation is not recommended due to dubious utility and potential for misleading information.