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Role of Electrocorticography at Surgery for Lesion-related Frontal Lobe Epilepsy

Published online by Cambridge University Press:  05 August 2019

Richard Wennberg ,
Luis Felipe Quesney ,
Andres Lozano ,
André Olivier  and
Theodore Rasmussen
Richard Wennberg
Affiliation:
Division of Neurology, The Toronto Hospital, University of Toronto
Luis Felipe Quesney*
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University
Andres Lozano
Affiliation:
Division of Neurosurgery, The Toronto Hospital, University of Toronto
André Olivier
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University
Theodore Rasmussen
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University
*
Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada H3A 2B4
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Abstract:

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Background:

The prognostic significance of epileptiform activity (EA) recorded intraoperatively at electrocorticography (ECOG) in patients with lesion-related frontal lobe epilepsy (FLE) is unknown.

Methods:

The results of ECOG performed in 22 patients with intractable FLE and a circumscribed frontal lobe structural lesion were compared with postoperative seizure control. Three patients underwent re-operation for a total of 25 cases, 23/25 with post-resection ECOG. Lesions were neoplasms (12), hamartomas (6) and arteriovenous malformations (4).

Results:

Outcomes were 15/25 Class I, 5/25 Class III and 5/25 Class IV (Engel classification). Class I outcome was associated with pre-excision EA recorded from ≤ 2 gyri (p < 0.05) and absence of EA, or EA limited to the resection border, at post-excision ECOG (p < 0.01). Complete lesion excision was highly correlated with Class I outcome (p < 0.001). The most significant correlations were seen when ECOG and lesionectomy variables were considered together: all 12 cases with complete lesionectomy and absent post-excision EA distant to the resection border had Class I outcome (p < 0.00015) and all 13 cases with complete lesionectomy and pre-excision EA recorded from ≤ 2 gyri had Class I outcome (p < 0.00005).

Conclusions:

Postoperative seizure control in lesion-related FLE is assured in the setting of complete lesion resection with pre-excision EA recorded from ≤ 2 gyri and no post-excision EA distant to the resection border; complete lesion excision is of paramount importance.

Résumé:

Résumé:<span class='italic'>Introduction:</span>

La signification pronostique de l'activité épileptiforme (AÉ) enregistrée par électrocorticographie (ÉCOG) peropératoire chez les patients atteints d'épilepsie frontale (ÉF) associée à une lésion est inconnue.

<span class='italic'>Méthodes:</span>

Nous avons étudié les résultats de l'ÉCOG effectuée chez 22 patients ayant une ÉF réfractaire au traitement et une lésion circonscrite du lobe frontal en relation avec le contrôle des crises en postopératoire. Trois patients ont subi une deuxième intervention pour un total de 25 cas, dont 23/25 ÉCOG post-résection. Les lésions étaient des néoplasmes (12), des hamartomes (6) et des malformations artérioveineuses (4).

<span class='italic'>Résultats:</span>

Selon la classification d'Engel, 15/25 ont été classés I, 5/25 ont été classés III et 5/25 IV. Les résultats de classe I étaient associés à une AÉ préexcision enregistrée de ≤ 2 gyri (p < 0,05) et absence d'AÉ, ou AÉ confinée à la limite de la résection à l'ÉCOG post-excision (p < 0,01). Une excision complète de la lésion était hautement corrélée à un résultat de classe I (p < 0,001). Les corrélations les plus significatives ont été observées quand les variables ÉCOG et excision de la lésion étaient considérées ensemble: les 12 cas chez qui l'excision de la lésion était totale et en l'absence d'AÉ post-excision à distance de la limite de résection avaient des résultats de classe I (p < 0,00015) et les 13 cas chez qui l'excision de la lésion était totale et qui avaient une AÉ préexcision enregistrée à ≤ 2 gyri avaient des résultats de classe I (p < 0,00005).

<span class='italic'>Conclusions:</span>

Le contrôle des crise en postopératoire dans l'ÉF reliée à une lésion est assuré dans le contexte de la résection complète de la lésion avec une AÉ pré-excision de ≤ 2 gyri et pas d'AÉ post-excision à distance de la limite de résection; l'excision complète de la lésion est donc très importante.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 1 , February 1999 , pp. 33 - 39
Copyright
Copyright © The Canadian Journal of Neurological 1999

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