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The use of cortical stimulation to induce artificial seizures in epileptic patients awaiting surgery could dramatically speed up their badessment while improving surgical outcomes, according to a new study released June 10 2019 in the Journal of the American Medical Association.
Patients with epilepsy with inserted electrodes often undergo cortical stimulation, a procedure that applies electrical current to the brain to map brain function, but also to induce convulsions to better understand the epileptic network. Image Credit: The Neuro
In about a third of cases of epilepsy, drug treatment fails and surgery is the only recourse. In such cases, patients must be hospitalized for up to two weeks in order to be screened. By recording this epileptic activity, the source is revealed, allowing surgeons to treat the right cortical area to inhibit future seizures.
However, this long period of hospitalization is not only a source of inconvenience for patients, it also puts a strain on the finances of health.
Cortical stimulation, using electrodes to stimulate the brain, is used in 20% of epileptic patients waiting for surgery. This not only helps doctors locate various functional areas in the brain, but can also be used to produce epileptic activity that helps to map the area of the cerebral cortex causing abnormal electrical activity.
However, the outcome of the surgery based on the results of this type of cortical stimulation has not yet been studied in a systematic way.
The purpose of this study was to determine whether routine recourse to cortical stimulation to induce seizures could help plan surgery while waiting for a spontaneous seizure.
The study uses data collected from a hundred or so epilepsy patients treated in tertiary centers of epilepsy in Canada and France. Under the direction of Dr. Birgit Frauscher, the researchers badyzed the results of cortical stimulation, used in 57% of patients. They sought to know if its use had successfully triggered seizures that resembled both electrically and clinically to the patient's spontaneous seizures. They also explored how planning based on cortical stimulation of the epileptic resection area was reflected in the patient's final outcome after surgery.
Statistics show that 70% of patients who had had seizures during their preoperative planning had performed well, compared with 48% of those who could not have a seizure. The areas of onset of seizures have also been successfully mapped by monitoring induced seizures, as well as for spontaneous seizures. In patients stimulated with a good surgical result, 63% of the contacts identified in the area of onset of the crisis were resected, but only 33% among those with a poor result. The corresponding figures for patients whose surgery was based on spontaneous seizure surveillance were 57% and 33%, respectively. The researchers also noted that it was easier to cause seizures after an interval of at least 24 hours since the last episode, to 65% compared to 27% with a shorter interval.
This would mean that there is strong evidence of the use of cortical stimulation to produce artificial convulsive seizures in order to locate the focus of seizures in the brain. Induced and spontaneous seizures are equally effective in mapping brain-seizure sites. In this case, the use of epileptic seizures could lead to a considerable reduction in the length of hospital stay, while considerably reducing costs.
Dr. Frauscher's clinic has already adopted routine cortical stimulation for patients with preoperative epilepsy. His team uses the insertion of electrodes at the beginning of the patient's stay to provoke convulsions and complete observation of the patient. According to her, it is highly likely that other facilities will follow the same trend given its great benefits.
Although brain mapping with cortical stimulation is not new, the study produced for the first time evidence that its use to induce seizures produced results very similar to spontaneous seizures. This procedure could therefore be performed early, thus reducing the length of time required for hospitalization.
Dr. Frauscher sums up his opinion: "I think it would be a huge advantage if this procedure was practiced in the first days of a patient's stay. Instead of being hospitalized for two weeks, patients may be present for 48 or 72 hours. and we only need to record perhaps one or more extra spontaneous fits, and that is a huge difference. "
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