title: Risk of seizures during intraoperative electrocortical stimulation of brain motor areas: a retrospective study on 50 patients.
abstract: Tumours close to cerebral cortices involved in motor and language functions represent a major challenge for neurosurgeons. Intraoperative neurophysiologic monitoring is useful to gain insight into the anatomy of and the relationship between pathological and normal tissues. In this study we report on the experience of electrocortical stimulation in the surgery of tumours adjacent to the motor cortex in 50 patients under general anaesthesia (26 under propofol, 24 under sevoflurane), and on EMG responses from contralateral muscles. In 18 patients stimulation evoked seizures, which were controlled only with antiepileptic drugs (36%). No difference was found in the incidence of intra-operative seizures between the patients with (10 out of 27) or without (8 out of 23) pre-operative epilepsy (p = 0.8685). The majority of the patients (13 out of 18) with intraoperative seizures were under sevoflurane (p = 0.01) and there was a statistically significant difference  in the mean electrical intensity used between the two groups, sevoflurane and propofol, respectively 5.3 ± 1.3 mA and 3.6 ± 2 mA (p = 0.03). Regarding pre-operative anti-epileptic drugs, the use of levitiracetam was associated with a high incidence of intraoperative seizure (5 out of 6 patients). 4 patients developed new, unwanted, permanent neurological deficits, of which 2 had intraoperative seizures controlled only with antiepileptic drugs. Electrocortical stimulation is a powerful tool to understand the functional organization of patients' eloquent areas. Intraoperative epileptic seizures may represent an unwanted complication preventing further stimulation and possibly worsening neurological results. The choice of anaesthetics according to the patients' characteristics, pre-op symptoms and medical therapy is pivotal.
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Via Celoria 11, 20133 Milan, Italy. rcordella@istituto-besta.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Cordella
authors.forename: Francesco
authors.initials: F
authors.lastname: Acerbi
authors.forename: Carlo Efisio
authors.initials: CE
authors.lastname: Marras
authors.forename: Carla
authors.initials: C
authors.lastname: Carozzi
authors.forename: Davide
authors.initials: D
authors.lastname: Vailati
authors.forename: Marco
authors.initials: M
authors.lastname: Saini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tringali
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferroli
authors.forename: Francesco
authors.initials: F
authors.lastname: Dimeco
authors.forename: Angelo
authors.initials: A
authors.lastname: Franzini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Broggi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000927:Anticonvulsants / Q000627:therapeutic use; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000601:surgery; D002648:Child; D056805:Consciousness Monitors; D004558:Electric Stimulation; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D038361:Neuronavigation; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011300:Preoperative Care; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants