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Risk of seizures during intraoperative electrocortical stimulation of brain motor areas: a retrospective study on 50 patients

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Abstract

Tumours close to cerebral cortices involved in motor and language functions represent a major challenge for neurosurgeons. Intraoperative neurophysiologic monitoring is useful to gain insight into the anatomy of and the relationship between pathological and normal tissues. In this study we report on the experience of electrocortical stimulation in the surgery of tumours adjacent to the motor cortex in 50 patients under general anaesthesia (26 under propofol, 24 under sevoflurane), and on EMG responses from contralateral muscles. In 18 patients stimulation evoked seizures, which were controlled only with antiepileptic drugs (36%). No difference was found in the incidence of intra-operative seizures between the patients with (10 out of 27) or without (8 out of 23) pre-operative epilepsy (p = 0.8685). The majority of the patients (13 out of 18) with intraoperative seizures were under sevoflurane (p = 0.01) and there was a statistically significant difference in the mean electrical intensity used between the two groups, sevoflurane and propofol, respectively 5.3 ± 1.3 mA and 3.6 ± 2 mA (p = 0.03). Regarding pre-operative anti-epileptic drugs, the use of levitiracetam was associated with a high incidence of intraoperative seizure (5 out of 6 patients). 4 patients developed new, unwanted, permanent neurological deficits, of which 2 had intraoperative seizures controlled only with antiepileptic drugs. Electrocortical stimulation is a powerful tool to understand the functional organization of patients' eloquent areas. Intraoperative epileptic seizures may represent an unwanted complication preventing further stimulation and possibly worsening neurological results. The choice of anaesthetics according to the patients' characteristics, pre-op symptoms and medical therapy is pivotal.

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Abbreviations

AED:

Anti-epileptic drug

BIS:

Bispectral index

ECS:

Electrocortical stimulation

EPC:

Epilepsia partialis continua

IOM:

Intraoperative monitoring

SE:

Standard error

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico “C. Besta”, Via Celoria 11, 20133, Milan, Italy

    Roberto Cordella, Francesco Acerbi, Carlo Efisio Marras, Marco Saini, Giovanni Tringali, Paolo Ferroli, Francesco DiMeco, Angelo Franzini & Giovanni Broggi

  2. Department of Neuroscience, Ospedale Bambin Gesù, Piazza Sant’Onofrio 4, 00165, Rome, Italy

    Carlo Efisio Marras

  3. Department of Anesthesiology, Fondazione IRCCS Istituto Neurologico “C. Besta”, Via Celoria, 11, 20133, Milan, Italy

    Carla Carozzi & Davide Vailati

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  1. Roberto Cordella
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  2. Francesco Acerbi
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Correspondence to Roberto Cordella.

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Cordella, R., Acerbi, F., Marras, C.E. et al. Risk of seizures during intraoperative electrocortical stimulation of brain motor areas: a retrospective study on 50 patients. Neurol Sci 34, 63–70 (2013). https://doi.org/10.1007/s10072-012-0968-2

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  • DOI: https://doi.org/10.1007/s10072-012-0968-2

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