Intraoperative electrocorticography: variants of periodic patterns in the structural epilepsy

Abstract

The results of intraoperative electrocorticography for patients with the structural epilepsy are influenced by two main factors: the action of general anesthetic and the mechanisms of epileptogenesis. Under the general anesthesia, there is a dose-dependent suppression of the bioelectrical activity of the brain; you could even register the “outburst-diminution” and “outburst-suppression” types of the periodic patterns. The study was carried out to classify the variants of periodic activity registered on the intraoperative electrocorticogram for patients with a structural epilepsy. The work was carried out during the examination and surgical treatment of the two groups of patients: 1) 19 patients (men/women — 10/9, 19–45 years old) with focal drug-resistant epilepsy; 2) 19 patients (men/women — 8/11, 28–68 years old) with structural epilepsy associated with the intracerebral tumors. All patients underwent surgical removal of the epileptic focus under a neurophysiological control. Surgical interventions were performed under the sevoflurane-based inhalation anesthesia in doses from 1.0−1.5 MAC (minimum alveolar concentration). Periodic activity on intraoperative electrocorticography was represented with the “outburst-suppression” type of patterns and patterns containing epileptiform discharge graph elements: “discharge- postdischarge depression,” “outburst-suppression” with discharges against the background of depression, “small electrical elements” with epileptiform discharges. The presence of discharge graph elements in the periodic patterns has a neurophysiological correlation with a drug-resistance in the structural epilepsy.

Keywords

bioelectrical activity of the brain / electrocorticography / periodic patterns / intraoperative neurophysiological monitoring / structural epilepsy / general anesthesia

References

[1] Petrovskii BV, Efuni SN. Lechebnyi narcoz. Moscow: Meditsina; 1967. (In Russ.).

[2] Петровский Б.В., Ефуни С.Н. Лечебный наркоз. Москва: Медицина, 1967.

[3] Stockard J, Bickford R. The neurophysiology of anesthesia. A basis and practice of neuroanesthesia. Gordon E, editor. New York: Excerpta Medica; 1981. P. 3–50.

[4] Stockard J., Bickford R. The neurophysiology of anesthesia. A basis and practice of neuroanesthesia. Gordon E., editor. New York: Excerpta Medica, 1981. P. 3–50.

[5] Aleksandrov MV, Kostenko IA, Arkhipova NB, et al. Suppression of brain electrical activity in general anesthesia: the dose-effect relationship. Bulleten of the military medical academy. 2018;20(4):79–85. (In Russ.). DOI:10.17816/brmma12279

[6] Александров М.В., Костенко И.А., Архипова Н.Б., и др. Подавление биоэлектрической активности головного мозга при общей анестезии: зависимость «доза-эффект» // Вестник Российской военно-медицинской академии. 2018. Т. 20, № 4. С. 79–85. DOI:10.17816/brmma12279

[7] Hirsch J, LaRoche SM, Gaspard N, et al. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol. 2013;(1):1–27. DOI:10.1055/A-1304-8038

[8] Hirsch J., LaRoche S.M., Gaspard N., et al. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2012 version // J Clin Neurophysiol. 2013. No. 1. P. 1–27. DOI:10.1055/A-1304-8038

[9] Abramov K., Ulitin A., Borovikova V., et al. Coherent analysis of interconnections in the drug-resistant multifocal epilepsy pathologic system [abstract]. Epilepsia. 2016;57(S2):79. DOI: 10.1111/epi.13609

[10] Abramov K., Ulitin A., Borovikova V., et al. Coherent analysis of interconnections in the drug-resistant multifocal epilepsy pathologic system [abstract]// Epilepsia. 2016. Vol. 57, S2. P. 79. DOI: 10.1111/epi.13609

[11] Mikhailov AYu, Berezina IYu, Sumsky LI, Arzumanov YuL. On the issue of the electroencephalographic phenomenon "burst-suppression": variants of outcomes and possible neurophysiological mechanisms. Medical alphabet. 2021;(5):42–49. (In Russ.). DOI: 10.33667/2078-5631-2021-5-42-49

[12] Михайлов А.Ю., Березина И.Ю., Сумский Л.И., Арзуматов Ю.Л. К вопросу об электроэнцефалографическом феномене «вспышка–подавление»: варианты исходов и возможные нейрофизиологические механизмы // Медицинский алфавит. 2021. № 5. С. 42–49. DOI: 10.33667/2078-5631-2021-5-42-49

[13] Huotari AM, Koskinen M, Suominen K, et al. Evoked EEG patterns during burst suppression with propofol. British Journal of Anaesthesia. 2004;92(1):18–24. DOI: 10.1093/bja/aeh022

[14] Huotari A.M., Koskinen M., Suominen K., et al. Evoked EEG patterns during burst suppression with propofol // British Journal of Anaesthesia. 2004. Vol. 92, No. 1. P. 18–24. DOI:10.1093/bja/aeh022

[15] Steriade M, Amzica F, Contreras D. Cortical and thalamic correlates of electroencephalographic burst-suppression. Electroencephalog. Clin Neurophysiol. 1994;(90):1–16. DOI: 10.1016/0013-4694(94)90108-2

[16] Steriade M., Amzica F., Contreras D. Cortical and thalamic correlates of electroencephalographic burst-suppression // Electroencephalog Clin Neurophysiol. 1994. No. 90. P. 1–16. DOI: 10.1016/0013-4694(94)90108-2

[17] Hughes SW, Crunelli V. Thalamic Mechanisms of EEG Alpha Rhythms and Their Pathological Implications. Neuroscientist. 2005;11(4):357–372. DOI:10.1177/1073858405277450

[18] Hughes S.W., Crunelli V. Thalamic Mechanisms of EEG Alpha Rhythms and Their Pathological Implications // Neuroscientist. 2005. Vol. 11, No. 4. P. 357–372. DOI:10.1177/1073858405277450

[19] Aleksandrov MV, Ulitin AYu. Intraoperative electrocorticography: possibilities and prospects. Bulletin of the Russian Military Medical Academy. 2012;(4):245–254. (In Russ.).

[20] Александров М.В., Улитин А.Ю. Интраоперационная электрокортикография: возможности и перспективы // Вестник Российской военно-медицинской академии. 2012. № 4. С. 245–254.

[21] Simon МV. Intraoperative Neurophysiologic Sensorimotor Mapping-А Review. J Neurol Neurophysiol. 2011;(3):3–17. DOI: 10.4172/2155-9562.S3-002

[22] Simon М.V. Intraoperative Neurophysiologic Sensorimotor Mapping-А Review // J Neurol Neurophysiol. 2011. No. 3. P. 3–17. DOI: 10.4172/2155-9562.S3-002

[23] Sonkajаrvi E, Rytky S, Alahuhta S, et al. Epileptiform and periodic EEG activities induced by rapid sevoflurane anaesthesia induction. J Clin Neurophysiol. 2018;129(3):638–645. DOI:10.1016/j.clinph.2017.12.037

[24] Sonkajаrvi E., Rytky S., Alahuhta S., et al. Epileptiform and periodic EEG activities induced by rapid sevoflurane anaesthesia induction // J Clin Neurophysiol. 2018. Vol. 129, No. 3. P. 638–645. DOI:10.1016/j.clinph.2017.12.037

Funding

Государственное задание(АААА-А19-119070490032-0)

RIGHTS & PERMISSIONS

Aleksandrov M.V., Kostenko I.A., Cherniy V.S., Tastanbekov M.M.