Magnetoencephalography using total intravenous anesthesia in pediatric patients with intractable epilepsy: lesional vs nonlesional epilepsy.
OBJECTIVE
Magnetoencephalography (MEG) provides source localization of interictal spikes. We use total intravenous anesthesia (TIVA) with propofol to immobilize uncooperative children. We evaluate the effect of TIVA on interictal spikes in children who have intractable epilepsy with or without MRI lesions.


METHODS
We studied 28 children (3-14 years; mean, 6.6). We intravenously administered propofol (30-60 microg/kg/min) to record MEG with simultaneous EEG. We evaluated MEG spike sources (MEGSSs). We compared spikes on simultaneous EEG under TIVA with those on scalp video-EEG without TIVA.


RESULTS
There was a significant decrease in frequent spikes (10 patients, 36%) on simultaneous EEG under TIVA compared to those (22 patients, 79%) on scalp video-EEG without TIVA (P<0.01). MEGSSs were present in 21 (75%) of 28 patients. Clustered MEGSSs occurred in 15 (83%) of 18 lesional patients but in 3 (30%) of 10 nonlesional patients (P<0.05). MEGSSs were more frequently absent in nonlesional (6 patients, 60%) than lesional (one patient, 5%) patients (P<0.01). Thirteen patients with MRI and/or histopathologically confirmed neuronal migration disorder most frequently showed clustered MEGSSs (11 patients, 85%) compared to those of other lesional and nonlesional patients.


CONCLUSIONS
Propofol-based TIVA reduced interictal spikes on simultaneous EEG. TIVA for MEG still had utility in identifying spike sources in a subset of pediatric patients with intractable epilepsy who were uncooperative and surgical candidates. In lesional patients, MEG under TIVA frequently localized the clustered MEGSSs. Neuronal migration disorders were intrinsically epileptogenic and produced clustered MEGSSs under TIVA. Nonlesional patients often had no MEGSS under TIVA.
The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8.
Ayataka
A
Fujimoto
Ayako
A
Ochi
Katsumi
K
Imai
Derrick
D
Chan
Rohit
R
Sharma
Amrita
A
Viljoen
Bill
B
Chu
Stephanie
S
Holowka
Sheelagh M
SM
Kemp
Sylvester H
SH
Chuang
Akira
A
Matsumura
Satoshi
S
Ayuzawa
O Carter
OC
Snead
Hiroshi
H
Otsubo
D000200:Action Potentials / Q000187:drug effects; D000293:Adolescent; D000771:Anesthesia, Intravenous / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000494:pharmacology; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000503:physiopathology; D004827:Epilepsy / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology*; D004829:Epilepsy, Generalized / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography / Q000379:methods*; D008297:Male; D010880:Piperidines / Q000008:administration & dosage / Q000494:pharmacology; D015742:Propofol / Q000008:administration & dosage / Q000494:pharmacology*; D000077208:Remifentanil; D012640:Seizures / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol