Concept of Epileptic System as a Basis for the Multifocal Intractable Epilepsy Surgery.
Abstract number :
3.184
Submission category :
Year :
2001
Submission ID :
2844
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
S.A. Chkhenkeli, MD, PhD, Neurology, University of Chicago, Chicago, IL; J.G. Milton, MD, PhD., Neurology, University of Chicago, Chicago, IL; V.L. Towle, PhD, Neurology, University of Chicago, Chicago, IL; J-P. Spire, MD, Neurology, University of Chicago
RATIONALE: Despite technological advances, especially in imaging procedures, the results of open (OS) and stereotactic surgery (SS) of epilepsy are not successful enough. The neuromonitoring data obtained from SEEG and ECoG evaluation of intractable epilepsy patients using the depth electrodes and subdural grids showed the advantage of the shift from the concept of a restricted [dsquote]epileptic focus[dsquote] (EF)to the concept of a [dsquote]dynamic epileptic system[dsquote].
METHODS: Based on the aforementioned premises 299 patients were operated upon for multifocal intractable epilepsy.The complex of presurgical and intrasurgical evaluation included the long-time electrophysiological monitoring using the multicontact depth intracerebral electrodes and subdural grids. The ECoG and depth EEG data were digitally processed and interstructural coherence study was performed. Combined SS of active elements of ES were performed in 194 patients. For 55 patients SS were combined with implantation of neurostimulators for therapeutic stimulation. For 23 patients SS were combined with simultaneous (OS). For 27 patients the temporal lobe resections were combined with other cortical topectomies or topectomies were performed in different cortical areas. All of those variants of surgical approaches were performed during one session. For the chronic therapeutic stimulation the head of nucleus caudatus and nucleus dentatus cerebelli have been employed.
RESULTS: Follow-up (1-16 years) was carried out in 241 patients. Absence of seizures was achieved in 39% of the patients, rare seizures (one or less per year) in 15%, significant (more than 50%) reduction of seizures in 29%, insignificant reduction in frequency of seizures (less than 50%) in 8%, without changes were 9% of patients. Mortality involved two cases of acute intracerebral hemorrhage. There were no other major complications or worsening of disease and no manifestation of additional neurological and/or neuropsychological deficit.
CONCLUSIONS: The concept of [dsquote]dynamic epileptic system[dsquote]can serve as a useful basis for the clinico-neurophysiological analysis of ES and beneficial surgical treatment of patients with intractable multifocal epilepsy.