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Temporolimbic Activation by Intracranial Electrical Stimulation

Published online by Cambridge University Press:  02 December 2014

Jorge A. Ure ,
André Olivier ,
Luis Felipe Quesney ,
Mauricio Bravo  and
Mónica Perassolo
Jorge A. Ure*
Affiliation:
Department of Neurology, Borda and Moyano Hospitals, Buenos Aires, Argentina
André Olivier
Affiliation:
Department of Neurosurgery, Montreal Neurological Institute and Hospital, Montréal PQ, Canada
Luis Felipe Quesney
Affiliation:
Department of Electroencephalography, Montreal Neurological Institute and Hospital, Montréal PQ, Canada
Mauricio Bravo
Affiliation:
Department of Electroencephalography, Montreal Neurological Institute and Hospital, Montréal PQ, Canada
Mónica Perassolo
Affiliation:
Department of Neurology, Borda and Moyano Hospitals, Buenos Aires, Argentina
*
Department of Neurology, Borda Hospital, Ramón Carrillo 375, Buenos Aires, Argentina
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Abstract

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Background:

To evaluate the results of intracranial electrical stimulation (ICES) as a pre-surgical tool in order to select the side of the operation in bitemporal lobe epilepsy (BTLE) patients who underwent depth electrode (DE) implantation.

Methods:

We reviewed the files of 77 medically intractable BTLE patients who underwent ICES with positive results through implanted DEs and then were under surgical treatment. One year or more after surgery, we evaluated the outcome. ICES was performed through: 1) Square-wave bipolar stimulation with symmetrical pulses of 60 Hz for 0.5 ms was delivered by a constant current Nuclear Chicago stimulator; 2) An initial intensity of 0.5 mA, and subsequently progressively stronger currents at 1-2 and occasionally 3 or 4 mA; 3) The duration of a single stimulation was usually 5 seconds; 4) The volume of tissue effectively stimulated did not exceed 5 mm.

Results:

We obtained habitual auras or seizures (clinical responses, CRs) in 74 patients and after-discharges, ADs in 61 of them, according to Engel's classification for post surgery outcomes. If CRs or ADs were obtained by stimulation of only one temporal lobe the result of epilepsy surgery tended to be better (Engel classes I or II) when the operation was done on the same side of positive CRs (15 cases) or ADs (14 cases), and tended to be worse (Engel classes III or IV) when the ICES had provoked bilateral responses or when the side operated on was contra-lateral to positive CRs (33 cases) or ADs (28 cases). Statistical analyses were performed in order to test these results and we found better post-operative results when the resection took place in the same side of positive responses to ICES (CRs: χ2 4.74 and p=0.0295; ADs: χ2 7.57 and p=0.0059).

Conclusion:

In addition to other methods (PET, MRI and neuropsychology) presurgical ICES can provide useful data in the process of identifying the temporal lobe to be targeted for resection in BTLE patients.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 5 , September 2009 , pp. 593 - 598
Copyright
Copyright © The Canadian Journal of Neurological 2009

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