title: Results of surgery in patients with refractory extratemporal epilepsy with normal or nonlocalizing magnetic resonance findings investigated with subdural grids.
abstract: OBJECTIVE
  To study the efficacy of extensive coverage of the brain surface with subdural grids in defining extratemporal cortical areas amenable for resection in patients with refractory extratemporal epilepy (R-ExTE) and normal or nonlocalizing magnetic resonance imaging (MRI) scans.
  
  
  METHODS
  Sixteen patients with R-ExTE were studied. Eleven patients had simple partial, eight had complex partial, and three had supplementary motor area seizures. Seizure frequency ranged from three per month to daily episodes. Interictal EEG showed large focal spiking areas in 11 patients, secondary bilateral synchrony in four, and was normal in one patient. Surface ictal recordings were nonlocalizing in six patients, and in 10, they disclosed large ictal focal spiking areas. MRI was normal in 10 patients, and in six patients, focal nonlocalizing potentially epileptogenic lesions were found. All patients were given an extensive coverage of the cortical convexity with subdural electrodes through large unilateral (n = 13) or bilateral (n = 3) craniotomies. Bipolar cortical stimulation was carried out through the implanted electrodes.
  
  
  RESULTS
  Interictal invasive recording findings showed widespread spiking areas in 13 patients and secondary bilateral synchrony in three. Ictal invasive recordings showed focal seizure onset in all patients. There were six frontal, two parietal, one temporooccipital, four rolandic, and three posterior quadrant resections. Thirteen patients had been rendered seizure free after surgery, and three had > or =90% of seizure-frequency reduction. Pathologic findings included gliosis (n = 10), cortical dysplasia (n = 5), or no abnormalities (n = 1). Six patients had transient postoperative neurologic morbidity.
  
  
  CONCLUSIONS
  Extensive subdural electrodes coverage seems to be an effective way to investigate patients with R-ExTE and normal or nonlocalizing MRI findings.
authors.affiliation: Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, Brazil. acukiert@uol.com.br
authors.forename: A
authors.initials: A
authors.lastname: Cukiert
authors.forename: J A
authors.initials: JA
authors.lastname: Buratini
authors.forename: E
authors.initials: E
authors.lastname: Machado
authors.forename: A
authors.initials: A
authors.lastname: Sousa
authors.forename: J O
authors.initials: JO
authors.lastname: Vieira
authors.forename: M
authors.initials: M
authors.lastname: Argentoni
authors.forename: C
authors.initials: C
authors.lastname: Forster
authors.forename: C
authors.initials: C
authors.lastname: Baldauf
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D003399:Craniotomy; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D008991:Monitoring, Physiologic; D009044:Motor Cortex / Q000503:physiopathology / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D013355:Subdural Space; D016896:Treatment Outcome; D014743:Videotape Recording