Occurence of Epileptic Seizures during Intraoperative Brain Stimulation – Our Experience

Czech version

Authors: T. Galanda ¹; J. Bullová ²; M. Klúzová ¹; J. Mištinová ³; M. Galanda ¹
Authors‘ workplace: Neurochirurgická klinika SZU a FNsP F. D. Roosevelta, Banská Bystrica ¹; Oddelenie anestéziológie a intenzívnej medicíny FNsP F. D. Roosevelta, Banská Bystrica ²; I. rádiologická klinika LF UK a UN Bratislava ³
Published in: Cesk Slov Neurol N 2012; 75/108(6): 748-753
Category: Short Communication

Poďakovanie Za štatistické spracovanie chceme poďakovať MUDr. Petrovi Jombíkovi, PhD., z neurologického odd. zvolenskej nemocnice.

Overview

Aim of the study:
To evaluate the relationship between intraoperative epileptic seizures evoked by direct electric stimulation of the brain and symptomatic epilepsy and parameters of the stimulation.

Methods:
The authors present monocentric retrospective analysis of 106 patients (50 men, 56 woman), in the age 15–82 years (average 52 years) who underwent surgery for pathological lesions localized within or near eloquent regions of the brain (low-grade glioma – 17, high-grade glioma – 34, metastasis – 29, meningioma – 19, others – 7) with utilization of direct cortical and subcortical stimulation at the authors’ institution between 2000–2009. For intraoperative mapping and monitoring of central structures of the brain continuous biphasic bipolar stimulation was used with frequency 100 or 50 Hz, pulse duration 1 ms, maximum intensity up to 18 mA, or stimulation with train of 5 pulses, interstimulus interval 2–4 ms, pulse width 0.4 ms, maximum intensity up to 30 mA, and repetition of trains 1 or 5 Hz. Evoked activity in contralateral muscles was monitored by EMG recording or by visual observation.

Results:
When patients with low-grade glioma had symptomatic epilepsy before operation, the risk of induction of intraoperative epileptic seizure was significantly higher (p = 0.06), in comparison to patients without epileptic seizure preoperatively or to patients with other pathologic lesion of the brain. Continuous stimulation with frequency 100 Hz and train with 5 Hz repetition rate evoked intraoperative focal epileptic seizures more often than continuous stimulation with frequency 50 Hz and train with 1 Hz repetition rate. However differences were not statistically important.

Conclusion:
The authors found significantly higher incidence of intraoperative focal epileptic seizures in patients with low grade glioma who had manifested epileptic seizures preoperatively.

Key words:
direct cortical stimulation – motor evoked potentials – stimulation induced seizures – symptomatic epilepsy

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