title: Intraoperative hyperventilation vs remifentanil during electrocorticography for epilepsy surgery - a case report.
abstract: BACKGROUND
  Traditionally, intraoperative intracranial electroen-cephalography-recordings are limited to the detection of the irritative zone defined by interictal spikes. However, seizure patterns revealing the seizure onset zone are thought to give better localizing information, but are impractical due to the waiting time for spontaneous seizures. Therefore, provocation by seizure precipitants may be used with the precaution that spontaneous and provoked seizures may not be identical.
  
  
  OBJECTIVE
  We present evidence that hyperventilation induced and drug induced focal seizures may arise from different brain regions in the same patient.
  
  
  METHODS
  Hyperventilation and ultra short acting opioid remifentanil were used separately as intraoperative precipitatants of seizure patterns, while recording from subdural and intraventricular electrodes in a patient with temporal lobe epilepsy. Two different ictal onset zones appeared in response to hyperventilation and remifentanil. Both zones were resected and the patient has remained essentially seizure free for 1 year. Furthermore, this is the first description of hyperventilation used as an intraoperative seizure precipitant in human focal epilepsy.
authors.affiliation: Department of Clinical Neurophysiology, Rigshospitalet University Hospital, Copenhagen, Denmark. neurology@dadlnet.dk <neurology@dadlnet.dk>
authors.forename: T W
authors.initials: TW
authors.lastname: Kjaer
authors.forename: F F
authors.initials: FF
authors.lastname: Madsen
authors.forename: F B
authors.initials: FB
authors.lastname: Moltke
authors.forename: P
authors.initials: P
authors.lastname: Uldall
authors.forename: H
authors.initials: H
authors.lastname: Hogenhaven
mesh_terms: D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D002540:Cerebral Cortex / Q000187:drug effects* / Q000601:surgery; D002648:Child; D004569:Electroencephalography / Q000187:drug effects* / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000139:chemically induced*; D007430:Intraoperative Care; D010880:Piperidines / Q000009:adverse effects*; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil