To assess the accuracy of intraoperative neurophysiological monitoring (IONM) in predicting immediate and 3-month postoperative neurological new deficit (or deterioration) in patients benefiting from ...spinal cord (SC) surgery; and to identify factors associated with a higher risk of postoperative clinical worsening.
Consecutive patients who underwent SC surgery with IONM were included. Pre and postoperative clinical (modified McCormick scale), radiological (lesion-occupying area ratio), and electrophysiological features were collected.
A total of 99 patients were included: 14 (14.1%) underwent extradural surgery, 50 (50.5%) intradural extramedullary surgery, and 35 (35.4%) intramedullary surgery. Cumulatively, multimodal IONM (motor and somatosensory evoked potentials, D-wave whenever possible) significantly predicted postoperative deficits (p<0.001), with a sensitivity, specificity, positive predictive value, and negative predictive value of 0.81, 0.93, 0.83, and 0.92, respectively. Sixty (60.6%) patients displayed no IONM change, whereas 39 (39.4%) displayed IONM worsening. In multivariate analysis, predictors for postoperative clinical worsening were: abnormal preoperative electrophysiological assessment (p=0.03), intramedullary tumor (p<0.001), lesion-occupying area ratio ≥0.7 (p<0.001), and IONM alterations (p<0.001). Three months after the surgical procedure, in patients presenting at least one of the risk factors described above, 45/81 (55.6%) and 19/81 (23.5%) were clinically and electrophysiologically improved, respectively; while 13/81 (16.0%) and 10/81 (12.3%) were clinically and electrophysiologically worsened.
Multimodal IONM is an essential tool to guide SC surgery, and enables the accurate prediction of postoperative neurological outcome. Specific attention should be given to patients presenting with preoperative electrophysiological abnormalities, large tumor volume, and intramedullary tumor location.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The subsequent reduction in the cerebral metabolic demand and blood flow also allows decreasing the intracranial pressure (ICP) 1. ...the suppression ratio (SR) provides a metric of the depth of ...sedation during general anesthesia 5. Since the target of thiopental sedation is to reach a discontinuous EEG activity (i.e., SR ≥ 10%); the aim of the herein study was to evaluate the relationship between the thiopental concentration and the SR in patients with a refractory SE or IH. Winer JW, Rosenwasser RH, Jimenez F. Electroencephalographic activity and serum and cerebrospinal fluid pentobarbital levels in determining the therapeutic end point during barbiturate coma.
•Relation between coffee consumption and seizure frequency might depend on dose.•There was no relation between coffee consumption and total seizure frequency.•The number of FBTCS was significantly ...associated with usual coffee consumption.•Moderate coffee consumption was associated with lower risk of FBTCS.•These results need to be confirmed in a dedicated prospective study.
To assess the relation between coffee consumption and seizure frequency in patients with drug-resistant focal epilepsy.
Cross-sectional analysis of data collected in the SAVE study, which included patients with drug-resistant focal epilepsy during long-term EEG monitoring. Patients in whom both coffee consumption and data about seizure frequency, including focal to bilateral tonic-clonic seizures (FBTCS), were available were selected. Coffee consumption was collected using a standardized self-report questionnaire and classified into four groups: none, rare (from less than 1 cup/week to up 3 cups/week), moderate (from 4 cups/week to 3 cups/day), and high (more than 4 cups/day).
Six hundred and nineteen patients were included. There was no relation between coffee consumption and total seizure frequency (p = 0.902). In contrast, the number of FBTCS reported over the past year was significantly associated with usual coffee consumption (p = 0.029). Specifically, number of FBCTS in patients who reported moderate coffee consumption was lower than in others. In comparison with patients with moderate coffee consumption, the odds ratio (95%CI) for reporting at least 1 FBTCS per year was 1.6 (1.03–2.49) in patients who never take coffee, 1.62 (1.02–2.57) in those with rare consumption and 2.05 (1.24–3.4) in those with high consumption. Multiple ordinal logistic regression showed a trend toward an association between coffee consumption and number of FBTCS (p = 0.08).
Our data suggest that effect of coffee consumption on seizures might depend on dose with potential benefits on FBTCS frequency at moderate doses. These results will have to be confirmed by prospective studies.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Because the spinal cord contains a rich concentration of longitudinal and transversal fibers in a very small area, intramedullary surgery could result in a high likelihood of morbidity. In this ...video, the authors demonstrate the microsurgical technique and surgical skills used to perform excision of an intramedullary ependyma. The authors also present tools (electrophysiology and neuroimaging) that are useful for surgical decision-making and planning, and thus are used intraoperatively, that allow safer and more effective resection of an intramedullary tumor.
Recent studies have shown that it is feasible to record simultaneously intracerebral EEG (icEEG) and functional magnetic resonance imaging (fMRI) in patients with epilepsy. While it has mainly been ...used to explore the hemodynamic changes associated with epileptic spikes, this approach could also provide new insight into human cognition. However, the first step is to ensure that cognitive EEG components, that have lower amplitudes than epileptic spikes, can be appropriately detected under fMRI. We compared the high frequency activities (HFA, 50-150Formula: see textHz) elicited by a reading task in icEEG-only and subsequent icEEG-fMRI in the same patients (Formula: see text), implanted with depth electrodes. Comparable responses were obtained, with 71% of the recording sites that responded during the icEEG-only session also responding during the icEEG-fMRI session. For all the remaining sites, nearby clusters (distant of 7Formula: see textmm or less) also demonstrated significant HFA increase during the icEEG-fMRI session. Significant HFA increases were also observable at the single-trial level in icEEG-fMRI recordings. Our results show that low-amplitude icEEG signal components such as cognitive-induced HFAs can be reliably recorded with simultaneous fMRI. This paves the way for the use of icEEG-fMRI to address various fundamental and clinical issues, notably the identification of the neural correlates of the BOLD signal.
La pharmacorésistance est définie comme l’échec de deux monothérapies bien conduites. Des associations de deux ou plus antiépileptiques sont parfois nécessaires mais avec des résultats pouvant rester ...insuffisants. La pharmacorésistance nécessite également une réévaluation diagnostique et de la stratégie thérapeutique.
Sur le plan diagnostic, le cadre syndromique doit être vérifié ou précisé. Des diagnostics différentiels doivent être envisagés pour ne pas méconnaître une fausse pharmacorésistance. Les comorbidités doivent également être recherchées et prises en charge car elles grèvent la qualité de vie et influe sur l’équilibre de l’épilepsie : troubles du sommeil, syndrome anxiodépressif, etc.
Sur le plan thérapeutique, l’observance doit être vérifiée et des interactions médicamenteuses doivent être recherchées. Optimiser les posologies peut être nécessaire, notamment en cas de situations physiologiques particulières (insuffisances rénale ou hépatique, grossesse, etc.). Des thérapeutiques non médicamenteuses peuvent également être envisagées : stimulateur du nerf vague, bilan préchirurgical, etc.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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