engleski

Invasive monitoring in preoperative evaluation of patients with pharmacoresistant epilepsy - our experiences

In the preoperative evaluation of patients with pharmacoresistant epilepsy modern diagnostic techniques could be divided into non-invasive and invasive. Non-invasive methods include: a) video-EEG recording (interictal and ictal) ; b) neuropsychological testing ; c) neuroradiological findings - 3T brain MRI, with specialized MRI techniques including MR spectroscopy, functional MRI with MR tractography, and MR volumetry ; d) nuclear-medicine methods – brain SPECT (Single photon emission computed tomography) and PET (Positron emission tomography) ; e) MEG (magnetoencephalography). Invasive methods include: a) Wada test ; b) semi-invasive video-EEG monitoring, using sphenoidal or foramen ovale electrodes ; c) invasive video-EEG monitoring, using subdural strip and grid as well as depth electrodes. Invasive EEG monitoring, by which selection of the type of intracranial electrodes and their placement depends on the localization of epileptogenic region, is used if MRI is nonlesional, if there is discrepancy between ictal or interictal EEG recordings and brain MRI, between the seizure semiology and the imaging findings and/or EEG recording, in the case of dual pathology and polytope changes, and in the case of positive brain MRI, when patomorphologic lesion is localized near motoric and eloquent cortex. Possible complications include intracranial haemorrhage, cortical lesions and infection. Using invasive monitoring we can very precisely determine the epileptogenic zone and increase the success of resective neurosurgical treatment. From April 2010, for the first time in Croatia and the region, we have performed invasive monitoring using Nicolet Cortical Stimulator with 128-channel amplifier in three patients with pharmacoresistant epilepsy. All three patients postoperatively experienced clinically significant improvement and are seizure free.

invasive monitoring; preoperative evaluation; pharmacoresistant epilepsy

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