Epilepsy surgery involving the sensory-motor cortex

被引:74
|
作者
Pondal-Sordo, Margarita
Diosy, David
Tellez-Zenteno, Jose F.
Girvin, John P.
Wiebe, Samuel
机构
[1] London Hlth Sci Ctr, Dept Clin Neurol Sci, London, ON, Canada
[2] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada
[3] Natl Inst Med Sci & Nutr Salvador Zubiran, Dept Neurol, Mexico City, DF, Mexico
关键词
extratemporal epilepsy; epilepsy surgery; perirolandic epilepsy; sensorimotor epilepsy;
D O I
10.1093/brain/awl305
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Our aim was to assess the outcome with regard to seizures and neurological function in unselected patients undergoing resective surgery involving the perirolandic area, with or without multiple subpial transections (MSTs). All patients who underwent perirolandic cortical resection or MSTs from 1979 to 2003 at the London Health Sciences Centre were identified. Patients were included if they had seizures originating in the perirolandic area, recorded with subdural electrodes, or if they had scalp recorded seizures and a congruent discrete epileptogenic lesion on MRI in the perirolandic area. Most patients had electrocorticography (ECoG) at the time of surgery. Data collected include pre-operative and post-operative neurological deficits, MRI findings, interictal and ictal scalp EEG, interictal and ictal subdural data, ECoG findings, type and extent of surgery, neuropathologic diagnoses, and seizure outcomes. We studied 52 patients (22 females). The average age at the time of surgery was 33 years, and the average post-operative follow-up was 4.2 years. The most frequent aetiologies were neoplastic in 26 patients (50%), vascular in eight (15%), malformations of cortical development in six (12%), Rasmussen's encephalitis in three (6%) and other aetiologies in nine (17%). Surgery involved the pre-central gyrus in 17 patients, pre- and post-central gyrus in 13, the inferior central region in 11, the post-central gyrus in 7, and the pre-central gyrus and mesial frontal area in 2. At last follow-up 16 patients were in Engel class I (31%), 8 (15%) in class II, 14 (27%) in class III and 14 (27%) in class IV. Residual neurological deficits were present in 26 patients (50%), occurred more frequently in patients >= 25 years old (P < 0.05) and were mild in 14 (54%) patients. In univariate analyses, better seizure outcomes (P < 0.05) occurred in patients whose ECoG showed infrequent post-resectional spikes and no spikes distant to the resection margin, and in resections involving the pre-central and inferior rolandic cortex. In unselected patients with intractable perirolandic epilepsy, many of whom have large, complex epileptogenic lesions, various levels of seizure improvement can be achieved in almost 75% through well-planned surgical resections. New, severe post-operative neurological deficits can occur in 23% of these patients and appear to be more frequent in older patients. Whereas scalp EEG provided limited information to guide surgery, findings on interictal ECoG predicted seizure outcome.
引用
收藏
页码:3307 / 3314
页数:8
相关论文
共 50 条
  • [21] APPRAISAL OF SENSORY-MOTOR ACTIVITIES
    DEWET, DR
    PSYCHOLOGIA AFRICANA, 1967, 12 (01): : 17 - 41
  • [22] COMPARISON OF MAGNETOENCEPHALOGRAPHY, FUNCTIONAL MRI, AND MOTOR EVOKED-POTENTIALS IN THE LOCALIZATION OF THE SENSORY-MOTOR CORTEX
    MORIOKA, T
    YAMAMOTO, T
    MIZUSHIMA, A
    TOMBIMATSU, S
    SHIGETO, H
    HASUO, K
    NISHIO, S
    FUJII, K
    FUKUI, M
    NEUROLOGICAL RESEARCH, 1995, 17 (05) : 361 - 367
  • [23] Sensory-motor cortex GABA level modulates motor network connectivity in progressive multiple sclerosis
    Inglese, M.
    Droby, A.
    Fleysher, L.
    Podranski, K.
    Marianska, M.
    Petracca, M.
    EUROPEAN JOURNAL OF NEUROLOGY, 2019, 26 : 662 - 662
  • [24] PLASTICITY IN SENSORY-MOTOR SYSTEMS
    HELD, R
    SCIENTIFIC AMERICAN, 1965, 213 (05) : 84 - &
  • [25] Interhemispheric asymmetry of the motor cortex excitability in stroke: relationship with sensory-motor impairment and injury chronicity
    Berenguer-Rocha, Marina
    Baltar, Adriana
    Rocha, Sergio
    Shirahige, Livia
    Brito, Rodrigo
    Monte-Silva, Katia
    NEUROLOGICAL SCIENCES, 2020, 41 (09) : 2591 - 2598
  • [26] NEURONAL-ACTIVITY AND MOTOR POTENTIALS IN SENSORY-MOTOR CORTEX OF MONKEYS DURING SPONTANEOUS MOVEMENTS
    GANTCHEV, G
    ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY, 1974, 37 (03): : 321 - 321
  • [27] Interhemispheric asymmetry of the motor cortex excitability in stroke: relationship with sensory-motor impairment and injury chronicity
    Marina Berenguer-Rocha
    Adriana Baltar
    Sérgio Rocha
    Lívia Shirahige
    Rodrigo Brito
    Kátia Monte-Silva
    Neurological Sciences, 2020, 41 : 2591 - 2598
  • [28] ETIOLOGY OF SENSORY-MOTOR STROKE
    ACOSTA, JA
    KAUL, S
    WOZNIAK, MA
    KITTNER, SJ
    MACKO, RF
    SLOAN, MA
    PRICE, TR
    NEUROLOGY, 1995, 45 (04) : A173 - A173
  • [29] ORDINALITY AND SENSORY-MOTOR SERIES
    KOPP, CB
    SIGMAN, M
    PARMELEE, AH
    CHILD DEVELOPMENT, 1973, 44 (04) : 821 - 823
  • [30] Sensory-motor problems in Autism
    Whyatt, Caroline
    Craig, Cathy
    FRONTIERS IN INTEGRATIVE NEUROSCIENCE, 2013, 7