Anesthesia and electrocorticography for epilepsy surgery: a Jordanian experience.
OBJECTIVE
Electrocorticography (ECoG) may be used to guide epilepsy surgery. However, anesthetics can suppress epileptiform activity or induce confounding burst-suppression patterns and the relationship between ECoG results and seizure outcome is controversial. In this study, we evaluated the ECoG activity under several different anesthetics and examined the relationship between ECoG and outcome.


METHODS
We retrospectively studied 44 patients who had ECoG during epilepsy surgery. Anesthesia was with fentanyl and isoflurane (n = 19), fentanyl and sevoflurane (n = 9), remifentanil and sevoflurane (n = 5), remifentanil and propofol (n = 9), and fentanyl with propofol sedation during local anesthesia (n = 2). Pre-resection ECoG was considered satisfactory if epileptiform activity was present and there was no burst-suppression. Post-resection ECoG was graded according to residual epileptiform activity: A (none), B (mild), C (moderate). Seizure outcome was graded: I (seizure free without medication), II (seizure free with medication), III (> 50% seizure reduction) or IV (< 50% seizure reduction). Grades I-III were considered beneficial.


RESULTS
ECoG was satisfactory in 43 of the 44 surgeries, but one of the 11 recordings during propofol showed no epileptiform activity. Thirty-six of 37 patients (97%) with ECoG grade A or B and five of seven patients (71%) with ECoG grade C benefited from epilepsy surgery. Chi-squared, p > 0.05.


CONCLUSIONS
Satisfactory ECoG is possible using isoflurane or sevoflurane with nitrous oxide and fentanyl or remifentanil or using propofol and remifentanil. However, one of eleven ECoGs under propofol was negative for epileptiform activity. The amount of post-resection ECoG epileptiform activity does not significantly correlate with seizure outcome.
Al-Ghanem
Subhi S M
SS
Dept. of Anesthesia and Intensive Care, Faculty of Medicine, Jordan University Hospital, P.O. Box: 13046, 11492 Amman, Jordan. alghanem@ju.edu.jo
Al-Oweidi
Abdelkarim S
AS
Tamimi
Ahmad F
AF
Al-Qudah
Abdelkarim A
AA
D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D000777:Anesthetics; D002648:Child; D003399:Craniotomy / Q000379:methods*; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005283:Fentanyl; D006801:Humans; D007530:Isoflurane; D007597:Jordan; D008137:Longitudinal Studies; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D012189:Retrospective Studies; D012640:Seizures / Q000145:classification / Q000628:therapy*; D000077149:Sevoflurane; D016896:Treatment Outcome; D055815:Young Adult
D000777:Anesthetics; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D007530:Isoflurane; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol