Electrocorticography-Guided Surgical Treatment of Solitary Supratentorial Cavernous Malformations with Secondary Epilepsy

Objective To evaluate the efficacy of electrocorticographic(ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy. Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years(mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated. Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I(75.00%), 5 were class II(13.89%), 2 were class III(5.56%), and 2 were class IV(5.56%), thus the total effective rate(class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes(P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes(P=0.041). Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes.

Electrocorticography with Direct Cortical Stimulation for a Left Temporal Glioma with Intractable Epilepsy

ELECTROCORTICOGRAPHY (ECoG), the intraoperative recording of cortical potentials, has played an important role in the surgical management of patients with medically intractable epilepsy. This technique is useful in epilepsy surgery to delineate margins of epileptogenic zones, guide resection,

Brief potentially ictal rhythmic discharges on intraoperative electrocorticography predict a good outcome of focal cortical dysplasia after surgical resection: a case report

Background Focal cortical dysplasia(FCD)is a common cause of drug-resistant epilepsy.Electroencephalography(EEG)biomarkers that predict good postoperative outcomes are essential for identifying patients with focal epilepsies.Case presentation We report the case of a 21-year-old female with seizure onset at the age of 9,characterized by left-hand dystonic posturing and impaired awareness,which evolved to bilateral tonic-clonic seizures,evaluated in a neurological referral center in Lima,Peru.During 6-h video-EEG,interictal EEG revealing focal brief potentially ictal rhythmic discharges(BIRDs)over the right frontal central region,lasting less than 10 s.The ictal features were characterized by low-voltage fast activity over the same area.Brain magnetic resonance imaging(MRI)demonstrated a focal lesion of focal cortical dysplasia type II in the right frontal lobe.The patient underwent a lesionectomy guided by electrocorticography,which showed continuous polyspikes.BIRDs showing a brief burst of spikes lasting longer than 0.5 s,were also identified on intraoperative electrocorticography(ECoG)and helped define the extent of resection.The patient obtained an Engel Outcome Class IA at 6 years of follow-up.Conclusions The atypical BIRDs on ECoG can be used as a prognostic biomarker for prolonged seizure-freedom outcome in patients with epilepsy.Additional reports are needed in developing countries with and without brain MRI lesions to advance outpatient presurgical evaluations despite limited resources.

Principles, Anatomical Origin and Applications of Brainwaves: A Review, Our Experience and Hypothesis Related to Microgravity and the Question on Soul

Brainwave is a kind of traceable neurophysiological energy in a living brain. Invisible to human eyes, it is only detectable using electroencephalography (EEG), electrocorticography (ECoG) and magnetoencephalography (MEG). The waves or oscillations or rhythms are produced mainly by the oscillatory networks of the brain. Three main oscillatory networks are thalamocortical, extrathalamic-cortical and cortical-cortical networks. Greater limbic system (reticular system, hypothalamus, thalamus, basal forebrain nuclei, limbic system) has a great influence on these oscillatory networks. This system which is in microgravity position lies deep inside and surrounded by the ventricles of the brain. It receives all information from inside and outside of our body and then projects to all areas of the brain (from all to one and from one to all—nearly similar concept to “from God back to God”). Therefore, the greater limbic system could be regarded as “a core of the neuroaxis” which lies in microgravity compartment and in microgravity position (“T”-shape or curving shape;whilst gravity position is “I”-shape or vertical shape). By knowing the origin of the brainwaves and methods to detect them, one may study seizure networks, normal and abnormal brain networks and arguably, even to explore the relationship between the “invisibles”: “invisible” brainwaves and “invisible” soul.

Communication of Internal Speech with Communicative Associative Robot via Spectral Neurointerface

Thought communications with an associative-communicative robot are carried out through the spectral neurointerface of internal speech.Internal speech is an energy physiological process.Internal speech is vibration from the mental vibration of thought.Mental vibration of thought is a process in the mental ethereal field.The vibrations of thoughts are reflected and observed by the mind in the form of semantic sensual images.Vibrations of semantic sensual images generate vibrations of internal speech action(internal speech)in the form of language communicative and associative stereotypes which are perceived by a touch zone of a brain of Wernicke.In­ternal speech is a linguistic mental vibration.It is felt and becomes internal­ly audible and drawn to attention.The perception of vibrations of internal speech is carried out through energy channels,such as the internal posterior median canal of the spine.The spectral neurointerface perceives these vi­brations.Neocortex makes us a reasonable person-allows us to think and talk.The spectral neurointerface is based on the principles of biosensors,bioenergy detectors,spectral analyzers and electrocorticography for neuro­imaging parts of the brain that record vibrations of internal speech,such as the lower frontal gyrus,the upper and middle temporal gyrus,the medial prefrontal cortex,the hind parts of the wedge and precline and the dark temporal region,including the posterior Internal speech activity is associat­ed with the semantic memory of the neocortex.

Treatment of Epilepsy with Bipolar Electro-coagulation： An Analysis of Cortical Blood Flow and Histological Change in Temporal Lobe

Background：Bipolar electro-coagulation has a reported efficacy in treating epilepsy involving functional cortex by pure electro-coagulation or combination with resection.However,the mechanisms of bipolar electro-coagulation are not completely known.We studied the acute cortical blood flow and histological changes after bipolar electro-coagulation in 24 patients with intractable temporal lobe epilepsy.Methods：Twenty-four patients were consecutively enrolled,and divided into three groups according to the date of admission.The regional cortical blood flow （rCBF）,electrocorticography,the depth of cortex damage,and acute histological changes （H and E staining,neuronal staining and neurofilament （NF） staining） were analyzed before and after the operation.The t-test analysis was used to compare the rCBF before and after the operation.Results：The rCBF after coagulation was significantly reduced （P 〈 0.05）.The spikes were significantly reduced after electro-coagulation.For the temporal cortex,the depth of cortical damage with output power of 2-9 W after electro-coagulation was 0.34 ± 0.03,0.48 ± 0.06,0.69 ± 0.06,0.84 ± 0.09,0.98 ± 0.08,1.10 ± 0.1 l,1.11 ± 0.09,and 1.22 ± 0.11 mm,respectively.Coagulation with output power of 4-5 W completely damaged the neurons and NF protein in the molecular layer,external granular layer,and external pyramidal layer.Conclusions：The electro-coagulation not only destroyed the neurons and NF protein,but also reduced the rCBF.We concluded that the injuries caused by electro-coagulation would prevent horizontal synchronization and spread of epileptic discharges,and partially destroy the epileptic focus.

igh-frequency Oscillations and the Seizure Onset Zones in Neocortical Epilepsy

Background： To study the characters of high-frequency oscillations （HFOs） in the seizure onset zones （SOZ） and the nonseizure onset zones （NSOZ） in the electrocorticography （ECoG） of patients with neocortical epilepsy. Methods： Only patients with neocortical epilepsy who were seizure-free after surgery as determined with ECoG were included. We selected patients with normal magnetic resonance imaging before surgery in order to avoid the influence of HFOs by other lesions. Three minutes preictal and 1 0 rain interictal ECoG as recorded in 39 channels in the SOZ and 256 channels in the NSOZ were analyzed. Ripples and fast ripples （FRs） were analyzed by Advanced Source Analysis soltware （ASA, The Netherlands）. Average duration of HFOs was analyzed in SOZ and NSOZ separately. Results： For ripples, the permillage time occupied by HFOs was 0.83 in NSOZ and 1.17 in SOZ during the interictal period. During preictal period, they were 2.02 in NSOZ and 7.93 in SOZ. For FRs, the permillage time occupied by HFOs was 0.02 in NSOZ and 0.42 in SOZ during the interictal period. During preictal period, they were 0.03 in NSOZ and 2 in SOZ. Conclusions： High-frequency oscillations are linked to SOZ in neocortical epilepsy. Our study demonstrates the prevalent occurrence of HFOs in SOZ. More and more burst of HFOs, especially FRs, means the onset of seizures.