Paradigms for Subdural Grids[ssquote] Implantation in Patients with Refractory Epilepsy and Non-Localizatory MRI.
Abstract number :
3.181
Submission category :
Year :
2001
Submission ID :
1945
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
J.A. Buratini, MD, Neurosurgery, Hospital Brigadeiro, Sao Paulo; A. Cukiert, MD, PhD, Neurosurgery, Hospital Brigadeiro, Sao Paulo; A. Sousa, MD, Neurosurgery, Hospital Brigadeiro, Sao Paulo; E. Machado, MD, Neurosurgery, Hospital Brigadeiro, Sao Paulo; J
RATIONALE: The need for invasive monitoring in patients with refractory epilepsy has been greatly reduced by the introduction of new technologies such as PET, SPECT and MRI in the clinical practice. On the other hand, 10 to 30% of the patients with refractory epilepsy have non-localizatory non-invasive preoperative workup results. This paper reports on the paradigms for subdural electrodes implantation in patients with different refractory epileptic syndromes and normal MRI.
METHODS: Thirty-eight adult refractory epileptic patients were studied. Patients were divided into 6 different epileptic syndromes: bitemporal (Group I; n=19), bi-fronto-mesial (Group II; n=7), hemispheric (Group III; n=2), anterior quadrant (GRoup IV; n=3), posterior quadrant (Group V; n=3) and rolandic (Group VI; n=4). All of them were submitted to extensive subdural electrodes[ssquote] implantation (from 64 to 160 contacts) covering all the cortical surface potentially involved in epileptogenesis, under general anesthesia.
RESULTS: All patients tolerated the procedure well. There was no sign or symptom of intracranial hypertension except for headache in 32 patients. In all but one Group II patient, prolonged eletrocorticographic monitoring using the described subdural cortical coverage patterns was able to define a focal area amenable for resection. In all group II-VI patients cortical stimulation was able to adequately map the rolandic and speach areas as needed.
CONCLUSIONS: Despite recent technological advances invasive neurophysiological studies are still necessary in some patients with refractory epilepsy. The standardization of the paradigms for subdural implantation coupled to the study of homogeneous patient[ssquote]s populations as defined by MRI will certainly lead to a better understanding of the pathophysiology involved in such patients and an improved surgical outcome.