Intra-operative cortical motor mapping using subdural grid electrodes in children undergoing epilepsy surgery evaluation and comparison with the conventional extra-operative motor mapping

Publication date: Available online 12 August 2018

Source: Clinical Neurophysiology

Author(s): Puneet Jain, Robyn Whitney, Samuel Strantzas, Blathnaid McCoy, Ayako Ochi, Hiroshi Otsubo, O Carter Snead, Shelly Weiss, Elizabeth Donner, Elizabeth Pang, Rohit Sharma, Amrita Viljoen, Anne Keller, James M. Drake, James T. Rutka, Cristina Go

Abstract

Objectives

The objective of this study was to review our experience with intra-operative "train of five" stimulation using subdural grid for motor mapping in children undergoing epilepsy surgery evaluation.

Methods

Twenty consecutive children below 18-years of age with drug-refractory epilepsy who underwent invasive-EEG monitoring using subdural-grid placement and intra-operative motor mapping using direct cortical stimulation by sub-dural grid elecrodes (IODCS-SDG) at our institution between January-2016 and June-2017 were reviewed. Stimulation was delivered through the subdural-grid electrodes using a train-of-five pulses and muscle responses were recorded by motor-evoked-potentials (MEPs). Intra-operative direct cortical stimulation delivered through a ball-tipped probe (IODCS-probe) and extra-operative motor-mapping (EODCS-SDG) were also performed.

Results

IODCS-SDG was completed in 20 patients and subsequent EODCS-SDG was done in 17/20 patients. MEP responses were more commonly obtained in the deltoid (19/20), extensor-digitorum-communis (20/20) and first-dorsal-interosseus (19/20). The median thresholds varied between 40 V and 60 V for the six muscle groups. The respective IODCS-probe thresholds tended to be similar. No stimulation-provoked seizures or anaesthesia-related complications were noted during IODCS-SDG. EODCS-SDG could not be completed in 4/17 children and mapping data obtained was frequently inadequate. . Nine patients demonstrated 100% concordance between IODCS-SDG and EODCS-SDG for the common mapped body regions. Stimulation-provoked seizures during EODCS-SDG were seen in 6/17 (35.3%) and after-discharges in 7/17 (41.2%) children.

Conclusions

IODCS-SDG could be performed safely in children with drug refractory epilepsy undergoing invasive EEG monitoring.

Significance

IODCS-SDG may be a useful adjunct to EODCS-SDG in motor mapping for children.

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