Abstract
BACKGROUND:: Fast ripples (FR, 250-500 Hz) detected with chronic intracranial electrodes are proposed biomarkers of epileptogenesis. This study determined whether resection of FR-containing neocortex recorded during intraoperative electrocorticography (ECoG) was associated with postoperative seizure freedom in pediatric patients with mostly extratemporal lesions. METHODS:: FRs were retrospectively reviewed in 30 consecutive pediatric cases. ECoGs were recorded at 2,000 Hz sampling rate and visually inspected for FR, with reviewer blinded to the resection and outcome. RESULTS:: Average age at surgery was 9.1 ± 6.7 years, ECoG duration was 11.8 ± 8.1 minutes, and postoperative follow-up was 27 ± 4 months. FRs were undetected in 6 ECoGs with remote or extensive lesions. FR episodes (n = 273) were identified in ECoGs from 24 patients, and in 64% FRs were independent of spikes, sharp waves, voltage attenuation, and paroxysmal fast activity. Of these 24 children, FR-containing cortex was removed in 19 and all became seizure-free, including 1 child after a second surgery. The remaining 5 children had incomplete FR resection and all continued with seizures postoperatively. In 2 ECoGs, the location of electrographic seizures matched FR location. FR-containing cortex was found outside of MRI and FDG-PET abnormalities in 6 children. CONCLUSION:: FRs were detected during intraoperative ECoG in 80% of pediatric epilepsy cases, and complete resection of FR cortex correlated with postoperative seizure freedom. These findings support the view that interictal FRs are excellent surrogate markers of epileptogenesis, can be recorded during brief ECoG, and could be used to guide future surgical resections in children.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1686-1694 |
| Number of pages | 9 |
| Journal | Neurology |
| Volume | 75 |
| Issue number | 19 |
| DOIs | |
| State | Published - Nov 9 2010 |
Funding
Dr. Wu serves on the professional advisory board for the Tuberous Sclerosis Alliance and receives research support from the Tuberous Sclerosis Alliance, Novartis, and the NIH (NINDS K23 NS051637 [PI] and NIMH R34 MH089299 [coinvestigator]). Dr. Sankar serves on scientific advisory boards for and has received funding for travel from Ortho-McNeil-Janssen Pharmaceuticals, Inc., NeuroTherapeutics Pharma, Inc., King Pharmaceuticals, and Valeant Pharmaceuticals International; receives royalties from the publication of Pediatric Neurology, 3rd ed . (Demos Publishing, 2008); serves on speakers' bureaus for and has received speaker honoraria from Ortho-McNeil-Janssen Pharmaceuticals, Inc., Valeant Pharmaceuticals International, UCB, Eisai Inc., GlaxoSmithKline, Lundbeck Inc., and Cyberonics, Inc.; and has received research support from Valeant Pharmaceuticals International, Marinus Pharmaceuticals, Inc., the NIH (NS046516 [PI], NS045911 [co-PI], NS059505 [co-I], and MH079933 [coinvestigator]), and the Epilepsy Foundation of America. Dr. Lerner receives research support from the Thrasher Research Fund and Lundbeck Inc. (formerly Ovation Pharmaceuticals, Inc.). Dr. Matsumoto reports no disclosures. Dr. Vinters serves on the editorial boards of the Journal of Neuroscience Research , Neuropathology & Applied Neurobiology , Korean Journal of Pathology , and Neuropathology (journal of the Japanese Society of Neuropathology); and holds stock in Minnesota Mining & Manufacturing, Teva Pharmaceutical Industries Ltd., GlaxoSmithKline, and Pfizer Inc. Dr. Mathern serves on the editorial boards of Neurology ®, Epileptic Disorders , Journal of Neuropathology & Experimental Neurology , Epilepsy & Seizures , Surgical Neurology International , and Epilepsy Research and on the Data Management Committee of Neuropace, Inc.; and received research support from NIH (R01 NS38992 [PI] and R21 NS606075 [PI]).
ASJC Scopus subject areas
- Clinical Neurology