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Epileptic Disorders

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Intraoperative ElectroCorticoGraphy (ECog): indications, techniques, and utility in epilepsy surgery Volume 16, issue 3, September 2014

TEST YOURSELF


(1) What is intraoperative ECoG?


(2) What is the use of intraoperative ECoG in temporal lobe epilepsy with mesial temporal sclerosis (MTS)
versus without MTS?


(3) What is the use of intraoperative ECoG in extra-temporal epilepsy with abnormal MRI versus without abnormal MRI?

 

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Answers


(1) It is an EEG monitoring technique performed during surgery, with the electrodes directly placed over surgically exposed cortex. It typically lasts 5-30 minutes. All anaesthetic agents affect the ECoG signal. Local anaesthetics for awake patients or light anaesthesia and holding short-acting anesthetics 10-20 minutes before recording are typically used during intraoperative ECoG monitoring.

 

(2) Use of intraoperative ECoG in temporal lobe epilepsy with mesial temporal sclerosis (MTS) is generally considered not necessary. Intraoperative ECoG in temporal lobe epilepsy without mesial temporal sclerosis may be useful to guide surgical resection of temporal lesions to achieve better seizure control, or to predict which patients are more likely to be seizure-free after surgery.

 

(3) Use of intraoperative ECoG in extra-temporal epilepsy with structural lesions likely increases resection of potentially epileptogenic cortex and improves seizure control, assuming eloquent cortex is not violated. Use of intraoperative ECoG in extra-temporal epilepsy without a structural lesion is useful to identify I/CEDs ("ictal or continuous epileptogenic discharges"). Excision of I/CEDs has been shown to correlate with favourable seizure control.

 

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