title: Electrocorticography discharge patterns in patients with a cavernous hemangioma and pharmacoresistent epilepsy.
abstract: OBJECTIVE
  Neurodevelopmental lesions (NDLs) such as glioneuronal tumors and cortical dysplasia produce characteristic electrocorticography (ECoG) discharge patterns. Because cavernomas, another congenital abnormality, are also associated with pharmacoresistant epilepsy, the authors wondered whether they exhibit discharge patterns similar to those occurring in NDLs.
  
  
  METHODS
  Intraoperative ECoG recordings from 19 patients with cavernomas and 54 with NDLs were reviewed for continuous spikes, bursts, or recruiting discharges and to determine whether these patterns were spatially coincident with the lesion. Relative densities of microglia and the intensity of Fe3+ staining in surgical samples were evaluated. Seizure outcome was assessed 1 year after surgery.
  
  
  RESULTS
  The mean ages at seizure onset and surgery were higher in patients in the cavernoma group than in the NDL group (22.5 and 36.4 years compared with 10.0 and 25.2 years, respectively). Neocortical discharge patterns occurred equally in patients with either cavernomas (53%) or NDLs (41%). In the mesiotemporal area coincident bursts occurred more often in patients with cavernomas than patients with NDLs (55% compared with 10%, respectively). Coincident continuous spiking was associated with a longer duration of epilepsy in patients with cavernomas (23.5 years compared with 11.4 years for those without coincident continuous spiking) and with a lower age at seizure onset in those with NDLs (4.1 years compared with 11.8 years for those without coincident continuous spiking). In the cavernoma group the absence of coincident bursts was associated with high microglia density. There were no associations between the intensity of Fe3+ staining and discharge patterns, although the discharge patterns were associated with a worse outcome in patients with NDLs.
  
  
  CONCLUSIONS
  In patients with NDLs, continuous spiking patterns may be markers of a widespread epileptogenic zone due to an early insult to the developing brain; in patients with cavernomas, such patterns may indicate secondary epileptogenesis. Microglia may inhibit discharge patterns in patients with cavernomas.
authors: Department of Clinical Neurophysiology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands. c.h.ferrier@neuro.azu.nl
authors: Cyrille H
authors: CH
authors: Ferrier
authors: Eleonora
authors: E
authors: Aronica
authors: Frans S S
authors: FS
authors: Leijten
authors: Wim G M
authors: WG
authors: Spliet
authors: Karin
authors: K
authors: Boer
authors: Peter C
authors: PC
authors: van Rijen
authors: Alexander C
authors: AC
authors: van Huffelen
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000002:abnormalities* / Q000503:physiopathology*; D004569:Electroencephalography; D004827:Epilepsy / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005911:Gliosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome