SENTINEL SPIKE IN PATIENTS WITH FRONTAL LOBE EPILEPSY (FLE)
Abstract number :
1.418
Submission category :
Year :
2003
Submission ID :
1920
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Meire Argentoni, Cristine M. Baldauf, Carla Baise, Cassio R. Forster, Valeria Mello, Leila Frayman, Rodio Brandao, Lauro Ceda, Joaquim O. Vieira, Jose A. Burattini, Pedro P. Mariani, Arthur Cukiert Neurology and Neurosurgery, Hospital Brigadeiro, Sao Paul
Patients with suspected FLE and normal MRI are often submitted to invasive recordings in order to define their epileptogenic areas. Invasive coverage may be unilateral, but is often bilateral due to the presence of intense secondary bilateral synchrony. A sentinel-generalized spike (SS) is often seen preceding the eletrocorticographic (ECoG) ictal onset pattern in these patients.
Eleven patients with suspected FLE and normal MRI were submitted to invasive recordings using extensive coverage with subdural electrodes (6 unilateral and 5 bilateral implants). In 5 patients, there was a generalized SS preceding the actual ECoG ictal onset pattern. The prevailing ictal onset pattern was a theta recruiting rhythm (7/11). The ictal phenomenology was synchronous with the ECoG ictal onset and not with the sentinel spike. All patients were submitted to extensive frontal lobe resection.
Five out of the 6 patients without SS have been rendered seizure-free by surgery. Only 1/5 patients with SS have been rendered seizure-free, although all of them got at least 80% seizure[rsquo]s frequency reduction. There was no significant morbidity or mortality.
SS is more frequently seen during ECoG. Surface video-EEG recordings rarely adequately define them. The presence of SS seems to carry a poorer prognosis in relation to seizure outcome and might correlate to more widespread epileptogenesis.