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Objective To discuss the application of awaking anesthesia and intraoperative cortico-subcortical electrostimulation in the surgery for patients with secondary epilepsy induced by lesions in eloquent areas. Methods A total of 11 patients initiated with epileptic seizure were collected in our study. All patients were right-handed and 5 had neurological dysfunction, and the mean Karnofsky performance status (KPS) scores were 87. Skull MRI and long-term video-EEG monitoring were performed for all patients, and 6 of them got functional MRI. The surgeries were performed under intravenous anesthesia: 4 got trachea intubation and the other 7 were performed pharyngeal esophageal intubation under awaking anesthesia. Electrocorticographic recordings were adopted to confirm the epileptogenic zone, and then cortical electrical stimulus was performed to locate the cortical functional area. Under subcortical electrostimulation monitoring, we resected the lesions by the methods of focal cortical resection or multiple subpial transaction (MST) according to the relation between epileptogenic zone and functional cortex; during the resection, subcortical electrostimulation was adopted to protect the tracts lay in the sub-cortex. Results Total resection was achieved in 10 patients, and subtotal excision in 1. The epileptogenic zone was performed cortical resection or pia mater-fiber transverse amputation.Two cases got transient hemiparalysis after operation. Followed up for 6-20 months, none of the patients had neurologic deficit, and the average KPS scores were 100. Epilepsies were well-controlled using only one antiepileptic drug. Conclusion Pharyngeal esophageal intubation under awaking anesthesia is safe and convenient. With the monitoring of intraoperative cortico-subcortical electrostimulation, we can resect the lesions up to the hilt and protect the eloquent areas effectively, and improve the life quality of patients.

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Objective To investigate the effect of functional hemispherectomy on intractable epilepsy with hemiparalysis. Methods From April 2002 to December 2007, 8 epileptic patients with hemisphere atrophy received functional hemispherectomy in 6 hospitals. Scalp and video EEG examinations revealed epileptic waves in all the patients, including 7 in the ipsilateral side and 1 in the contralateral side. Magnetic resonance imaging (MRI) indicated hemisphere atrophy and ventriculomegaly in all the patients. Risk factors for epilepsy were found in all the patients, including 3 with hyperpyrexia, 2 with spontaneous intracranial hemorrhage, 2 with traumatic brain injury, and 1 with viral encephalitis (also suspected of Rasmussen's encephalitis). Hemispberectomy was performed based on the methods of Rasmussen and Schramm. Results All the patients were followed up postoperatively for 8 months to 6.4 years (mean 2.8 years). Satisfactory outcomes (including disappearance of seizures) were achieved in 6 patients, but 1 of them experienced seizure reoccurrence because of personal withdraw of antiepileptic drugs 2 years after total seizure relief, and was successfully managed by administration of another two antiepileptic drugs. Significant improvement was achieved in the other case, in which the seizure frequency was reduced by over 70%. The postoperative dose or number of the antiepileptic drugs was reduced in 6 patients, and 2 patients no longer required any medication. No death or serious complications occurred in these patients except for 1 patient who suffered acute status epilepticns perioperatively and was successfully managed. Postoperative EEG revealed the absence of epileptic waves in 6 patients. Two patients showed epileptic waves on the contralateral side. Paralysis aggravation was not observed in 7 patients, and 1 patient experienced temporal muscle weakness, which recovered gradually. Six patients showed improved limb functions, but the thumb function failed to recover. The patients became gentle and cooperative after the operation, and 4 were able to receive formal education. Two patients were capable of carrying out housework, and 2 stayed at home. Conclusion Functional hemispherectomy is effective for management of intractable epilepsy with paralysis and causes low rate of complications.

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<p><b>OBJECTIVE</b>Using the functional connectivity analysis based on the underlying neurophysiological characteristic that epileptic discharges can induce change of brain default mode, to develop a technique for epileptogenic localization using functional MRI (fMRI) without simultaneous electroencephalography (EEG).</p><p><b>METHODS</b>A data-driven method that jointly employed independent component analysis and functional connectivity analysis was used for the resting functional MRI data analysis of 12 focal epileptic patients. The independent components were ranged according to the coefficients of the negative correlation between independent component time course and the signal temporal course in the region of posterior cingulate cortex. The results were comparatively studied with simultaneous EEG-fMRI.</p><p><b>RESULTS</b>In the 10 successful results from 12 patients underwent EEG-fMRI examination, the outcomes of eight subjects were concordant with pathological foci. While the results of all 10 patients processed by data-driven method were concordant with pathological foci, besides the other patients who failed to perform EEG-fMRI examination. Meanwhile, the default mode was well mapped in all patients.</p><p><b>CONCLUSIONS</b>The default mode-based functional connectivity analysis can localize the epileptogenic foci effectively without simultaneous EEG, besides to detect the default mode of epileptic patients.</p>

Asunto(s)

Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Epilepsia , Diagnóstico , Imagen por Resonancia Magnética , Métodos

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Objective To observe the brain activation of interictal epiletiform discharges(IEDs) and to localize the epileptogenic foci of epilepsy.Methods The electroencephalogram(EEG)and functional MRI data of 12 focal epileptic patients were acquired using a combination of EEG and functional MRI simultaneously.The IEDs onset time detected with EEG were set as the time parameters in an event- related paradigm of functional MRI analysis.The spatial and temporal characters of IEDs activation were analyzed in detail.In order to confirm the consistency of this method,all patients were scanned repeatedly and the results were correlated with clinical evaluation.Results Of the 12 patients,valid data from EEG- fMRI were obtained from 10 patients in a total of 18 sessions..Compared with the structural foci,the epileptic foci localization results of eleven sessions were good,five sessions were fairly good,and two sessions were poor.The results obtained from six patients in two separate sessions were concordant.respectively.Moreover,thalamic activation was detected in ten sessions,cerebellar activation was detected in all sessions,and the deactivation was found in the default mode loci in nine sessions. Conclusion The method of performing EEG and fMRI simultaneously can potentially be a useful tool in epilepsy research.