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Kons ZA, Kokkinos V, Hadanny A, Muñoz W, Sisterson N, Simon M, Urban A, Richardson RM. Specific afterdischarge properties can enhance the clinical utility of electrical stimulation mapping during intracranial monitoring. Clin Neurophysiol 2024; 159:13-23. [PMID: 38241911 DOI: 10.1016/j.clinph.2023.12.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/19/2023] [Accepted: 12/12/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Extraoperative electrical cortical stimulation (ECS) facilitates defining the seizure onset zone (SOZ) and eloquent cortex. The clinical relevance of stimulation-induced afterdischarges (ADs) is not well defined. METHODS Fifty-five patients who underwent intracranial electroencephalogram evaluations with ECS were retrospectively identified. ADs were identified in these recordings and categorized by pattern, location, and association with stimulation-induced seizures. RESULTS ADs were generated in 1774/9285 (19%) trials. Rhythmic spikes and irregular ADs within the stimulated bipolar contact pair were predictive of location within the SOZ compared to non-epileptogenic/non-irritative cortex (rhythmic spikes OR 2.24, p = 0.0098; irregular OR 1.39; p = 0.013). ADs immediately preceding stimulated seizures occurred at lower stimulation intensity thresholds compared to other stimulations (mean 2.94 ± 0.28 mA vs. 4.16 ± 0.05 mA respectively; p = 0.0068). CONCLUSIONS Changes in AD properties can provide clinically relevant data in extraoperative stimulation mapping. SIGNIFICANCE Although not exclusive to the SOZ, the generation of rhythmic spikes may suggest that a stimulation location is within the SOZ, while decreased stimulation intensity thresholds eliciting ADs may alert clinicians to a heightened probability of seizure generation with subsequent stimulation.
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Affiliation(s)
- Zachary A Kons
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Amir Hadanny
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - William Muñoz
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mirela Simon
- Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Urban
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Lesser RP, Webber WRS, Miglioretti DL. Pan-cortical electrophysiologic changes underlying attention. Sci Rep 2024; 14:2680. [PMID: 38302535 PMCID: PMC10834435 DOI: 10.1038/s41598-024-52717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
We previously reported that pan-cortical effects occur when cognitive tasks end afterdischarges. For this report, we analyzed wavelet cross-coherence changes during cognitive tasks used to terminate afterdischarges studying multiple time segments and multiple groups of inter-electrode-con distances. We studied 12 patients with intractable epilepsy, with 970 implanted electrode contacts, and 39,871 electrode contact combinations. When cognitive tasks ended afterdischarges, coherence varied similarly across the cortex throughout the tasks, but there were gradations with time, distance, and frequency: (1) They tended to progressively decrease relative to baseline with time and then to increase toward baseline when afterdischarges ended. (2) During most time segments, decreases from baseline were largest for the closest inter-contact distances, moderate for intermediate inter-contact distances, and smallest for the greatest inter-contact distances. With respect to our patients' intractable epilepsy, the changes found suggest that future therapies might treat regions beyond those closest to regions of seizure onset and treat later in a seizure's evolution. Similar considerations might apply to other disorders. Our findings also suggest that cognitive tasks can result in pan-cortical coherence changes that participate in underlying attention, perhaps complementing the better-known regional mechanisms.
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Affiliation(s)
- Ronald P Lesser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - W R S Webber
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, Davis, School of Medicine, University of California, Davis, CA, 95616, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
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Li H, Ren Y, Meng Q, Liu Y, Wu H, Dong S, Liu X, Zhang H. Stimulation induced aura during subdural recording: A useful predictor of postoperative outcome in refractory epilepsy. Seizure 2022; 101:149-155. [PMID: 36027686 DOI: 10.1016/j.seizure.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Electrical cortical stimulation (ECS) is a routine procedure commonly conducted in intracranial EEG (iEEG) monitoring in refractory epilepsy and associated with postoperative outcome in stereoelectroencephalography (SEEG) exploration. To better understand this effective method, this study aimed to examine the role of ECS in subdural recording. METHODS The ECS results of 144 consecutive patients who were monitored via subdural electrodes and received epilepsy surgery were retrospectively collected. The occurrence of stimulation induced aura (SIA) and seizure (SIS) and their distributions as well as their associations with postoperative outcomes were analyzed. RESULTS Among all 144 patients, 47.2% (68/144) achieved Engel class I recovery with a mean follow-up of 6.6±2.2 years (2.0-9.8 years). The percentages of patients who showed SIA and SIS were 16.0% (23/144) and 43.8% (63/144), respectively. Our data indicated that 30.4% (42/138) of SIS occurred in frontal lobe, which was significantly higher than the 7.7% (10/130) occurred in temporal lobe and the 8.5% (11/129) in parieto-occipital region (p<0.001). Meanwhile, no such distribution difference was discovered in SIA (p=0.229). Univariate and multifactorial analyses showed that SIA was the only independent predictor for postoperative outcome and patients with SIA were 4.8 times more likely to achieve seizure-free (95% CI 1.557-14.789, p = 0.006). CONCLUSIONS Our study demonstrated that SIS sites are more likely to be located in the frontal lobe and SIA independently predicts optimal postoperative outcome in subdural recording.
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Affiliation(s)
- Huanfa Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China
| | - Yutao Ren
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Qiang Meng
- Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Yong Liu
- Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Hao Wu
- Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China
| | - Shan Dong
- Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China
| | - Xiaofang Liu
- Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China
| | - Hua Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Comprehensive Epilepsy Center, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; Clinical Research Center for Refractory Epilepsy of Shaanxi Province, Xi'an 710061, China.
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Fábera P, Uttl L, Kubová H, Tsenov G, Mareš P. Adenosine Kinase Isoforms in the Developing Rat Hippocampus after LiCl/Pilocarpine Status Epilepticus. Int J Mol Sci 2022; 23:ijms23052510. [PMID: 35269653 PMCID: PMC8910300 DOI: 10.3390/ijms23052510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 01/27/2023] Open
Abstract
LiCl/pilocarpine status epilepticus (SE) induced in immature rats leads, after a latent period, to hippocampal hyperexcitability. The excitability may be influenced by adenosine, which exhibits anticonvulsant activity. The concentration of adenosine is regulated by adenosine kinase (ADK) present in two isoforms—ADK-L and ADK-S. The main goal of the study is to elucidate the changes in ADK isoform expression after LiCl/pilocarpine SE and whether potential changes, as well as inhibition of ADK by 5-iodotubercidin (5-ITU), may contribute to changes in hippocampal excitability during brain development. LiCl/pilocarpine SE was elicited in 12-day-old rats. Hippocampal excitability in immature rats was studied by the model of hippocampal afterdischarges (ADs), in which we demonstrated the potential inhibitory effect of 5-ITU. ADs demonstrated significantly decreased hippocampal excitability 3 days after SE induction, whereas significant hyperexcitability after 20 days compared to controls was shown. 5-ITU administration showed its inhibitory effect on the ADs in 32-day-old SE rats compared to SE rats without 5-ITU. Moreover, both ADK isoforms were examined in the immature rat hippocampus. The ADK-L isoform demonstrated significantly decreased expression in 12-day-old SE rats compared to the appropriate naïve rats, whereas increased ADK-S isoform expression was revealed. A decreasing ADK-L/-S ratio showed the declining dominance of ADK-L isoform during early brain development. LiCl/pilocarpine SE increased the excitability of the hippocampus 20 days after SE induction. The ADK inhibitor 5-ITU exhibited anticonvulsant activity at the same age. Age-related differences in hippocampal excitability after SE might correspond to the development of ADK isoform levels in the hippocampus.
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Affiliation(s)
- Petr Fábera
- Department of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, 14200 Prague, Czech Republic; (L.U.); (H.K.); (G.T.); (P.M.)
- Department of Neurology, Second Faculty of Medicine, Motol University Hospital, Charles University, 15006 Prague, Czech Republic
- Correspondence: ; Tel.: +42-073-272-8308; Fax: +42-022-443-6875
| | - Libor Uttl
- Department of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, 14200 Prague, Czech Republic; (L.U.); (H.K.); (G.T.); (P.M.)
- National Institute of Mental Health, 25067 Klecany, Czech Republic
| | - Hana Kubová
- Department of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, 14200 Prague, Czech Republic; (L.U.); (H.K.); (G.T.); (P.M.)
| | - Grygoriy Tsenov
- Department of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, 14200 Prague, Czech Republic; (L.U.); (H.K.); (G.T.); (P.M.)
- National Institute of Mental Health, 25067 Klecany, Czech Republic
| | - Pavel Mareš
- Department of Developmental Epileptology, Institute of Physiology, Czech Academy of Sciences, 14200 Prague, Czech Republic; (L.U.); (H.K.); (G.T.); (P.M.)
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Li H, Dong S, Meng Q, Liu Y, Du C, Li K, Liu X, Wu H, Zhang H. Disparate properties of afterdischarges elicited by electric cortical stimulation in MRI lesional epilepsy patients with different surgical outcomes. Clin Neurol Neurosurg 2021; 212:107034. [PMID: 34863054 DOI: 10.1016/j.clineuro.2021.107034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to demonstrate the prognostic value of afterdischarges(ADs) on surgical outcome by comparing the disparate properties in epilepsy patients with different surgical outcomes METHODS: 27 lesional epilepsy patients were retrospectively analyzed. The brain region covered by subdural electrodes in each patient was dichotomized into the area of the brain lobe(s) where the MRI lesion is located (region ML) and other brain areas (region nML). The occurrence of ADs and ADs evolving into clinical seizure, ADs threshold and ADs duration in region ML and nML were compared between seizure-free (SF) and non-seizure-free (nSF) patients. RESULTS A total of 2535 contacts were analyzed, and the total occurrence of ADs was 18.6% (471/2535). The overall occurrence of ADs in region ML (24.8%) was significantly higher than that in region nML (10.3%) (P < 0.001). In region ML, compared with SF patients, nSF patients had a lower occurrence of ADs (19.2% vs. 31.2%, P < 0.001), a higher occurrence of ADs evolves into clinical seizure (8.7% vs. 2.4%, P = 0.006), a higher ADs threshold (12.8 ± 4.1 mA vs. 11.0 ± 3.7 mA, P < 0.001) and a shorter ADs duration (15.3 ± 14.2 s vs. 20.6 ± 17.0 s, P < 0.001). However, in region nML, there was no significant difference in properties of ADs between SF and nSF patients. CONCLUSION Higher occurrence of ADs in region ML might predict a good outcome, whereas higher occurrence of ADs evolving into clinical seizure, higher ADs threshold and shorter ADs duration might predict an unfavorable surgical outcome. ADs might help predict surgical outcomes in epilepsy patients.
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Affiliation(s)
- Huanfa Li
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Shan Dong
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Qiang Meng
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Yong Liu
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Changwang Du
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Kuo Li
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Xiaofang Liu
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China
| | - Hao Wu
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China; Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710048, China.
| | - Hua Zhang
- Department of Neurosurgery, Clinical Research Center for Refractory Epilepsy of Shaanxi Province, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an 710061, China; Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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Lesser RP, Webber WRS, Miglioretti DL, Pillai JJ, Agarwal S, Mori S, Morrison PF, Castagnola S, Lawal A, Lesser HJ. Cognitive effort decreases beta, alpha, and theta coherence and ends afterdischarges in human brain. Clin Neurophysiol 2019; 130:2169-2181. [PMID: 31399356 DOI: 10.1016/j.clinph.2019.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Mental activation has been reported to modify the occurrence of epileptiform activity. We studied its effect on afterdischarges. METHOD In 15 patients with implanted electrodes we presented cognitive tasks when afterdischarges occurred. We developed a wavelet cross-coherence function to analyze the electrocorticography before and after the tasks and compared findings when cognitive tasks did or did not result in afterdischarge termination. Six patients returned for functional MRI (fMRI) testing, using similar tasks. RESULTS Cognitive tasks often could terminate afterdischarges when direct abortive stimulation could not. Wavelet cross-coherence analysis showed that, when afterdischarges stopped, there was decreased coherence throughout the brain in the 7.13-22.53 Hz frequency ranges (p values 0.008-0.034). This occurred a) regardless of whether an area activated on fMRI and b) regardless of whether there were afterdischarges in the area. CONCLUSIONS It is known that cognitive tasks can alter localized or network synchronization. Our results show that they can change activity throughout the brain. These changes in turn can terminate localized epileptiform activity. SIGNIFICANCE Cognitive tasks result in diffuse brain changes that can modify focal brain activity. Combined with a seizure detection device, cognitive activation might provide a non-invasive method of terminating or modifying seizures.
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Affiliation(s)
- Ronald P Lesser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - W R S Webber
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, CA 95616, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | - Jay J Pillai
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Shruti Agarwal
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Susumu Mori
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Peter F Morrison
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Stefano Castagnola
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Adeshola Lawal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Helen J Lesser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Dineen J, Maus DC, Muzyka I, See RB, Cahill DP, Carter BS, Curry WT, Jones PS, Nahed BV, Peterfreund RA, Simon MV. Factors that modify the risk of intraoperative seizures triggered by electrical stimulation during supratentorial functional mapping. Clin Neurophysiol 2019; 130:1058-1065. [DOI: 10.1016/j.clinph.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/05/2019] [Accepted: 03/13/2019] [Indexed: 12/19/2022]
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Gollwitzer S, Hopfengärtner R, Rössler K, Müller T, Olmes DG, Lang J, Köhn J, Onugoren MD, Heyne J, Schwab S, Hamer HM. Afterdischarges elicited by cortical electric stimulation in humans: When do they occur and what do they mean? Epilepsy Behav 2018; 87:173-179. [PMID: 30269940 DOI: 10.1016/j.yebeh.2018.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/09/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Afterdischarges (ADs) are a common and unwanted byproduct of direct cortical stimulation during invasive electroencephalography (EEG) recordings. Brief pulse stimulation (BPS) can sometimes terminate ADs. This study investigated AD characteristics and their relevance for emergence of stimulation seizures. In addition, AD response to BPS was analyzed. MATERIAL AND METHODS Invasive EEG recordings including mapping with direct cortical stimulation in patients with refractory epilepsy at the Erlangen Epilepsy Center were retrospectively reviewed. Afterdischarge defined as stimulation-induced rhythmic epileptiform discharges of more than a two-second duration were analyzed regarding incidence, localization, duration, propagation pattern, morphology, and seizure emergence. In addition, the influence of AD characteristics and stimulation settings on BPS success rate was studied. RESULTS A number of 4261 stimulation trials in 20 patients were investigated. Afterdischarge occurred in 518 trials (14.2%) and lasted 12.4 s (standard deviation [SD]: 8.6 s) on average. We elicited ADs in the seizure onset zone (SOZ) (n = 64; 19.4%), the irritative zone (n = 105, 20.0%), and outside the irritative area (n = 222, 12.5%). Rhythmic spikes (30.5%) and spike-wave complexes (30.3%) represented predominant morphologies. Afterdischarge morphology in the SOZ and hippocampus differed from other areas with polyspikes and sequential spikes being the most common types there (p = 0.0005; p < 0.0001 respectively). Hippocampal ADs were particularly frequent (n = 50, 38.2%) and long-lasting (mean: 16.6, SD: 8.3 s). Brief pulse stimulation was applied in 18.1% of the AD trials (n = 94) and was successful in 37.4% (n = 40). Success rates were highest when BPS was delivered within 9.5 s (p = 0.0048) and in ADs of spike-wave morphology (p = 0.0004). Fifteen clinical seizures emerged from ADs (3.55%), mostly evolving from sequential spikes. Afterdischarges in patients with stimulation seizures appeared more widespread (p < 0.0001) and lasted longer (mean duration 7.0 s) than in those without (mean duration 21.0 s, p = 0.0054). CONCLUSION Afterdischarges appear in the epileptogenic and nonepileptogenic cortex. Duration and propagation patterns can help to quantify the risk of stimulation seizures, with sequential spikes being most susceptible to seizure elucidation. The hippocampus is highly sensitive to AD release. Brief pulse stimulation is a safe and efficacious way to terminate ADs, especially when delivered quickly after AD onset.
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Affiliation(s)
- Stephanie Gollwitzer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
| | | | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Tamara Müller
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - David Gerhard Olmes
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Johannes Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Julia Köhn
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Müjgan Dogan Onugoren
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Jana Heyne
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Schwab
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Hajo Martinus Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Erlangen, Germany
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Hampel KG, Gómez-Ibáñez A, Garcés-Sánchez M, Hervás-MarÃn D, Cano-López I, González-Bono E, Conde-Sardón R, Gutiérrez-MartÃn A, Villanueva V. Antiepileptic drug reduction and increased risk of stimulation-evoked focal to bilateral tonic-clonic seizure during cortical stimulation in patients with focal epilepsy. Epilepsy Behav 2018; 80:104-108. [PMID: 29414538 DOI: 10.1016/j.yebeh.2017.12.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/23/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Stimulation-evoked focal to bilateral tonic-clonic seizure (FBTCS) can be a stressful and possibly harmful adverse event for patients during cortical stimulation (CS). We evaluated if drug load reduction of antiepileptic drugs (AEDs) during CS increases the risk of stimulation-evoked FBTCS. MATERIAL AND METHODS In this retrospective cohort study, we searched our local database for patients with drug-resistant epilepsy who underwent invasive video-EEG monitoring and CS in the University Hospital la Fe Valencia from January 2006 to November 2016. The AED drug load was calculated with the defined daily dose. We applied a uni- and multivariate logistic regression model to estimate the risk of stimulation-evoked FBTCS and evaluate possible influencing factors. Furthermore, we compared patients whose AEDs were completely withdrawn with those whose AEDs were not. RESULTS Fifty-eight patients met the inclusion criteria and were included in the analysis. Stimulating 3806 electrode contact pairs, 152 seizures were evoked in 28 patients (48.3%). Ten seizures (6.6%) in seven patients (12.1%) evolved to FBTCS. In the univariate and multivariate analysis, a 10% reduction in drug load was associated with an increase of the odds ratio (OR) of stimulation-evoked FBTCS by 1.9 (95%-CI 1.2, 4.0, p-value=0.04) and 1.9 (95%-CI 1.2, 4.6, p-value=0.04), respectively. In patients, whose AEDs were completely withdrawn the OR of FBTCS increased by 9.1 (95%CI 1.7, 69.9, p-value=0.01) compared with patients whose AEDs were not completely withdrawn. No other factor (implantation type, maximum stimulus intensity, number of stimulated contacts, history of FBTCS, age, gender, or epilepsy type) appears to have a significant effect on the risk of stimulation-evoked FBTCS. CONCLUSIONS The overall risk of stimulation-evoked FBTCS during CS is relatively low. However, a stronger reduction and, especially, a complete withdrawal of AEDs are associated with an increased risk of stimulation-evoked FBTCS.
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Affiliation(s)
- Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain; Department of Psychobiology/IDOCAL, University of Valencia, Avenida Blasco Ibáñez 21, 46010, Valencia, Spain.
| | - Asier Gómez-Ibáñez
- Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Mercedes Garcés-Sánchez
- Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - David Hervás-MarÃn
- Biostatistics Unit, Health Research Institute La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Irene Cano-López
- Department of Psychobiology/IDOCAL, University of Valencia, Avenida Blasco Ibáñez 21, 46010, Valencia, Spain
| | - Esperanza González-Bono
- Department of Psychobiology/IDOCAL, University of Valencia, Avenida Blasco Ibáñez 21, 46010, Valencia, Spain
| | - Rebeca Conde-Sardón
- Refractory Epilepsy Unit, Neurosurgery Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Antonio Gutiérrez-MartÃn
- Refractory Epilepsy Unit, Neurosurgery Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
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