Abstract
Epilepsy surgery has revolutionized the management of treatment-resistant focal epilepsy. Its success is based on the total resection of the epileptogenic zone (EZ) in the absence of any neurologic (e.g., motor, sensory, and cognitive) deficits. Clearly, the ideal candidate is a patient with focal epilepsy with an EZ that does not involve eloquent cortex and is easily accessible to surgical resection and in whom the noninvasive studies of the presurgical evaluation can yield concordant data of the neurophysiologic (interictal and ictal electrographic recordings), structural (e.g., high-resolution brain MRI) and functional (e.g., positron emission tomography [PET]) neuroimaging studies and neuropsychological evaluation. Unfortunately such is not the case in a significant percentage of patients, for one of the following reasons: (1) the presurgical evaluation fails to yield concordant localizing data among the various diagnostic studies; (2) the epileptogenic zone cannot be localized or even lateralized in a reliable manner; (3) the epileptogenic zone appears to be close to or involve eloquent cortex. Under those circumstances, there is a need to recur to invasive EEG monitoring with intracranial electrodes. Specifically, these are the circumstances when intracranial recordings should be considered:
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References
Nathan SS, Lesser RP, Gordon B, Thakor NV. Electrical stimulation of the human cerebral cortex. Theoretical approach. Adv Neurol. 1993;63:61–85.
Lesser RP, Gordon B. Methodological considerations in cortical electrical stimulation in adults. New York: Churchill Livingstone; 2000.
Brummer SB, Robblee LS, Hambrecht FT. Criteria for selecting electrodes for electrical stimulation: theoretical and practical considerations. Ann N Y Acad Sci. 1983;405:159–71.
De Salles AA, Swartz BE, Lee TT, Delgado-Escueta AV. Subdural recording and electrical stimulation for cortical mapping and induction of usual seizures. Stereotact Funct Neurosurg. 1994;62(1–4):226–31.
Geddes LA, Roeder R. Criteria for the selection of materials for implanted electrodes. Ann Biomed Eng. 2003;31(7):879–90.
Luders HO, Lesser RP, Dinner DS, et al. Localization of cortical function: new information from extraoperative monitoring in patients with epilepsy. Epilepsia. 1988;29 Suppl 2:S56–65.
Lüders HO. Symptomatogenic areas and electrical cortical stimulation. In: Lüders HO, Noachtar S, editors. Epileptic seizures: pathophysiology and clinical semiology. Philadelphia: Churchill Livingstone; 2000. p. 129–40.
Lesser RP, Lüders HO, Klem G, et al. Extraoperative cortical functional localization in patients with epilepsy. J Clin Neurophysiol. 1987;4(1):27–53.
Krauss GL, Fisher R, Plate C, et al. Cognitive effects of resecting basal temporal language areas. Epilepsia. 1996;37(5):476–83.
Laplane D, Talairach J, Meininger V, et al. Motor consequences of motor area ablations in man. J Neurol Sci. 1977;31(1):29–49.
Laplane D, Talairach J, Meininger V, et al. Clinical consequences of corticectomies involving the supplementary motor area in man. J Neurol Sci. 1977;34(3):301–14.
Broca P. Remarques sur le seige de la faculte du language articule, suivies d’une observation d’aphemie (perte de la parole). Bull Soc Anat. 1861;36:330–57.
Wernicke C. Der aphasische Symptomencomplex. Eine psychologische Studie auf anatomischer Basis. Breslau: M. Cohn und Weigert; 1874.
Penfield W, Boldrey E. Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain. 1937;60:389–443.
Uematsu S, Lesser R, Fisher RS, et al. Motor and sensory cortex in humans: topography studied with chronic subdural stimulation. Neurosurgery. 1992;31(1):59–71. Discussion 71–2.
Fried I, Katz A, McCarthy G, et al. Functional organization of human supplementary motor cortex studied by electrical stimulation. J Neurosci. 1991;11(11):3656–66.
Lee HW, Hong SB, Seo DW, et al. Mapping of functional organization in human visual cortex: electrical cortical stimulation. Neurology. 2000;54(4):849–54.
Lesser RP, Lüders HO, Klem G, et al. Cortical afterdischarge and functional response thresholds: results of extraoperative testing. Epilepsia. 1984;25(5):615–21.
Gordon B, Lesser RP, Rance NE, et al. Parameters for direct cortical electrical stimulation in the human: histopathologic confirmation. Electroencephalogr Clin Neurophysiol. 1990;75(5):371–7.
Lüders HO, Dinner DS, Morris HH, et al. Cortical electrical stimulation in humans. The negative motor areas. Adv Neurol. 1995;67:115–29.
Lesser RP, Arroyo S, Crone N, Gordon B. Motor and sensory mapping of the frontal and occipital lobes. Epilepsia. 1998;39 Suppl 4:S69–80.
Lüders HO, Lesser RP, Dinner DS, et al. A negative motor response elicited by electrical stimulation of the human frontal cortex. Adv Neurol. 1992;57:149–57.
Penfield W, Rasmussen T. The cerebral cortex of man. A clinical study of localization of function. New York: Macmillan; 1957.
Lüders HO, Lesser RP, Dinner DS, et al. The second sensory area in humans: evoked potential and electrical stimulation studies. Ann Neurol. 1985;17(2):177–84.
Lüders HO, Lesser RP, Hahn J, et al. Basal temporal language area demonstrated by electrical stimulation. Neurology. 1986;36(4):505–10.
Ojemann JG, Ojemann GA, Lettich E. Cortical stimulation mapping of language cortex by using a verb generation task: effects of learning and comparison to mapping based on object naming. J Neurosurg. 2002;97(1):33–8.
Ojemann G, Ojemann J, Lettich E, Berger M. Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg. 1989;71(3):316–26.
Ojemann GA. Cortical organization of language. J Neurosci. 1991;11(8):2281–7.
Ojemann G. Organizations of language cortex derived from investigations during neurosurgery. Semin Neurosci. 1990;2:297–305.
Ojemann GA. Individual variability in cortical localization of language. J Neurosurg. 1979;50(2):164–9.
Ojemann G, Mateer C. Human language cortex: localization of memory, syntax, and sequential motor-phoneme identification systems. Science. 1979;205(4413):1401–3.
Goodglass H, Kaplan E, Weintraub S. Boston naming test. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 1976.
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Kanner, A.M., Morcillo, M.C.A. (2016). Mapping of Eloquent Cortex in Focal Epilepsy with Intracranial Electrodes. In: Byrne, R. (eds) Functional Mapping of the Cerebral Cortex. Springer, Cham. https://doi.org/10.1007/978-3-319-23383-3_7
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