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P31-T Burst-suppression pattern is not always predicting poor prognosis in children
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
P29-T Mapping primary motor cortex with navigated TMS in unusual corticospinal lateralization for epilepsy surgery— Cid Aurelio Delgado Pugley a, Alba León Jorba a,*, Nuria Álvarez López-Herrero a, Yiyang Lin-Miao a, Alessandro Príncipe b (a Clinical Neurophysiology Department, Hospital del Mar, Barcelona, Spain, b Epilepsy Unit, Neurology Department, Hospital del Mar, Spain) ⇑
Corresponding author.
Background: The corticospinal tract has a sequential development in which the ipsilateral projections are gradually withdrawn, whereas the contralateral projections persist. A unilateral lesion in the motor cortex during early life may cause a reorganization in this process with preservation of uncrossed corticospinal connections in the spared hemisphere. As a result, all the motor function is lateralized in one hemisphere. Individuals with this kind of lesions also have an increased risk of drug-resistant epilepsy and may be candidates for epilepsy surgery. In these cases, it is important to evaluate the motor function for surgical treatment. Material and methods: We present a series of 4 patients with pharmacoresistant epilepsy and early-life primary motor cortex lesion that were studied for epilepsy surgery. We used nTMS to investigate if there was still functional motor activity in one or both frontal cortices. Results: In three cases there was no activity in the pathological cortex obtaining a bilateral response in the normal cortex. Two of them underwent fMRI using a motor task showing bilateral motor cortical function in one patient, and unilateral activation of ipsilateral motor cortex in the other patient. The last patient showed a crossed response. Two patients were operated without new postoperative deficits. Conclusions: nTMS helps to define unusual lateralization of motor cortex and to guide a secure resection with the least motor deficits. doi:10.1016/j.clinph.2019.04.392
P30-T Localizing value of interictal electrical source imaging: Who are the best candidates?—Laurent Koessler a,b,*, Chifaou Abdallah b, Estelle Rikir b,d, Anne Thiriaux g, Martine Gavaret e,f, Fabrice Bartolomei e,f, Sophie Colnat-Coulbois a,c, Louis a,b a Maillard ( CNRS, UMR7039, Neuroscience Systems & Cognition, Nancy, France, b University Hospital, Neurology Department, Epilepsy Unit, Nancy, France, c University Hospital, Neurosurgery Department, Nancy, France, d University Hospital of Sart-Tilman, Neurology Department, Liege, Belgium, e University Hospital la Timone, Clinical Neurophysiology Department, Marseille, France, f INSERM, UMR1106, Institut des Neurosciences des systèmes, Marseille, France, g University Hospital, Neurology Department, Reims, France) ⇑
Corresponding author.
We aimed to prospectively assess the anatomical concordance of electric source localizations of interictal discharges with the epileptogenic zone (EZ) estimated by stereo-electroencephalography (SEEG) according to different subgroups: the type of epilepsy, the presence of a structural MRI lesion, the aetiology and the depth of the EZ. In a prospective multicentric observational study, we enrolled 85 consecutive patients undergoing pre-surgical SEEG investigation. Electric source imaging (ESI) was performed before SEEG. Anatomical concordance between ESI and EZ was defined according to 36 predefined sublobar regions. ESI was interpreted blinded toand subsequently compared with SEEG estimated EZ.
e47
74 patients were finally analyzed. 38 patients had temporal and 36 extra-temporal lobe epilepsy. MRI was positive in 52. 41 patients had malformation of cortical development (MCD), 33 had another or an unknown aetiology. EZ was medial in 27, lateral in 13, and mediolateral in 34. In the overall cohort, ESI completely or partly localized the EZ in 85%: full concordance in 13 cases and partial concordance in 50 cases. The rate of ESI full concordance with EZ was significantly higher in (i) frontal lobe epilepsy (46%; p = 0.05), (ii) cases of negative MRI (36%; p = 0.01) and (iii) MCD (27%; p = 0.03). We demonstrated that ESI more accurately estimated the EZ in subgroups of patients who are often the most difficult cases in epilepsy surgery: frontal lobe epilepsy, negative MRI and the presence of MCD. doi:10.1016/j.clinph.2019.04.393
P31-T Burst-suppression pattern is not always predicting poor prognosis in children—Vladislav Voitenkov a,*, Michael Sinkin b, Natalia Skripchenko a (a Pediatric Research and Clinical Center for Infectious Diseases, Saint-Petersburg, Russia, b NV Sklifosovsky Research Institute of Emergency Care, Moscow, Russia) ⇑
Corresponding author.
Among the numerous pathological changes of the EEG in critical conditions burst-suppression pattern (BSP) is considered to be most ominous and indicating the poor prognosis. BSP is diagnosed when 50% of all EEG is replaced by the isoelectric flatline, interchanged with normal amplitude bursts. BSP is best studied in adults; in pediatric critical care its less explored. We have seen the clinical case of the 5-years old girl with critical condition due to viral encephalitis who had typical BSP for 7 days; no general anesthetics were used during this time; afterwards her condition significantly improved, consciousness restored. BSP accordingly disappeared from her EEG. Thus, BSP in pediatric population indicates severe disruption of the bioelectric activity of the brain. In some pediatric cases although, this pattern is not indicating inevitable poor prognosis and clinical condition may be improved after the proper intensive care is applied. Also this clinical case demonstrates the necessity to perform EEG as often as possible in children with critical illness; also we are stressing out the clinical usefulness in these cases of the somatosensory evoked potentials (SSEPs), which are independent of drug profile of intensive care and were proved decisive as a prognostic tool in these conditions. doi:10.1016/j.clinph.2019.04.394
P32-T Connecting technologies for protecting brains and saving futures—Aexey Ivanov *, Gabriel Variane (Neurosoft, Ivanovo, Russian Federation) ⇑
Corresponding author.
‘‘PBSF – Protecting brains & Saving Futures” – is a big national project in Brazil. The main goal of this project is to decrease infant mortality and increase quality of neonatal service not only in big cities, but also all over the country. Within this project, our international team designed specialized neonatal monitor, which contains cerebral oximeter ‘‘Medtronic INVOS 5100C” and cerebral function monitor ‘‘Neurosoft Neuromonitor”. Both of this combined systems now can work together and show both oxygen saturation and electrical activity of the brain on one screen as a trends. Now this project combine 14 hospitals in different parts of Brazil, where such combined monitors are installed. All this
P29-T Mapping primary motor cortex with navigated TMS in unusual corticospinal lateralization for epilepsy surgery— Cid Aurelio Delgado Pugley a, Alba León Jorba a,*, Nuria Álvarez López-Herrero a, Yiyang Lin-Miao a, Alessandro Príncipe b (a Clinical Neurophysiology Department, Hospital del Mar, Barcelona, Spain, b Epilepsy Unit, Neurology Department, Hospital del Mar, Spain) ⇑
Corresponding author.
Background: The corticospinal tract has a sequential development in which the ipsilateral projections are gradually withdrawn, whereas the contralateral projections persist. A unilateral lesion in the motor cortex during early life may cause a reorganization in this process with preservation of uncrossed corticospinal connections in the spared hemisphere. As a result, all the motor function is lateralized in one hemisphere. Individuals with this kind of lesions also have an increased risk of drug-resistant epilepsy and may be candidates for epilepsy surgery. In these cases, it is important to evaluate the motor function for surgical treatment. Material and methods: We present a series of 4 patients with pharmacoresistant epilepsy and early-life primary motor cortex lesion that were studied for epilepsy surgery. We used nTMS to investigate if there was still functional motor activity in one or both frontal cortices. Results: In three cases there was no activity in the pathological cortex obtaining a bilateral response in the normal cortex. Two of them underwent fMRI using a motor task showing bilateral motor cortical function in one patient, and unilateral activation of ipsilateral motor cortex in the other patient. The last patient showed a crossed response. Two patients were operated without new postoperative deficits. Conclusions: nTMS helps to define unusual lateralization of motor cortex and to guide a secure resection with the least motor deficits. doi:10.1016/j.clinph.2019.04.392
P30-T Localizing value of interictal electrical source imaging: Who are the best candidates?—Laurent Koessler a,b,*, Chifaou Abdallah b, Estelle Rikir b,d, Anne Thiriaux g, Martine Gavaret e,f, Fabrice Bartolomei e,f, Sophie Colnat-Coulbois a,c, Louis a,b a Maillard ( CNRS, UMR7039, Neuroscience Systems & Cognition, Nancy, France, b University Hospital, Neurology Department, Epilepsy Unit, Nancy, France, c University Hospital, Neurosurgery Department, Nancy, France, d University Hospital of Sart-Tilman, Neurology Department, Liege, Belgium, e University Hospital la Timone, Clinical Neurophysiology Department, Marseille, France, f INSERM, UMR1106, Institut des Neurosciences des systèmes, Marseille, France, g University Hospital, Neurology Department, Reims, France) ⇑
Corresponding author.
We aimed to prospectively assess the anatomical concordance of electric source localizations of interictal discharges with the epileptogenic zone (EZ) estimated by stereo-electroencephalography (SEEG) according to different subgroups: the type of epilepsy, the presence of a structural MRI lesion, the aetiology and the depth of the EZ. In a prospective multicentric observational study, we enrolled 85 consecutive patients undergoing pre-surgical SEEG investigation. Electric source imaging (ESI) was performed before SEEG. Anatomical concordance between ESI and EZ was defined according to 36 predefined sublobar regions. ESI was interpreted blinded toand subsequently compared with SEEG estimated EZ.
e47
74 patients were finally analyzed. 38 patients had temporal and 36 extra-temporal lobe epilepsy. MRI was positive in 52. 41 patients had malformation of cortical development (MCD), 33 had another or an unknown aetiology. EZ was medial in 27, lateral in 13, and mediolateral in 34. In the overall cohort, ESI completely or partly localized the EZ in 85%: full concordance in 13 cases and partial concordance in 50 cases. The rate of ESI full concordance with EZ was significantly higher in (i) frontal lobe epilepsy (46%; p = 0.05), (ii) cases of negative MRI (36%; p = 0.01) and (iii) MCD (27%; p = 0.03). We demonstrated that ESI more accurately estimated the EZ in subgroups of patients who are often the most difficult cases in epilepsy surgery: frontal lobe epilepsy, negative MRI and the presence of MCD. doi:10.1016/j.clinph.2019.04.393
P31-T Burst-suppression pattern is not always predicting poor prognosis in children—Vladislav Voitenkov a,*, Michael Sinkin b, Natalia Skripchenko a (a Pediatric Research and Clinical Center for Infectious Diseases, Saint-Petersburg, Russia, b NV Sklifosovsky Research Institute of Emergency Care, Moscow, Russia) ⇑
Corresponding author.
Among the numerous pathological changes of the EEG in critical conditions burst-suppression pattern (BSP) is considered to be most ominous and indicating the poor prognosis. BSP is diagnosed when 50% of all EEG is replaced by the isoelectric flatline, interchanged with normal amplitude bursts. BSP is best studied in adults; in pediatric critical care its less explored. We have seen the clinical case of the 5-years old girl with critical condition due to viral encephalitis who had typical BSP for 7 days; no general anesthetics were used during this time; afterwards her condition significantly improved, consciousness restored. BSP accordingly disappeared from her EEG. Thus, BSP in pediatric population indicates severe disruption of the bioelectric activity of the brain. In some pediatric cases although, this pattern is not indicating inevitable poor prognosis and clinical condition may be improved after the proper intensive care is applied. Also this clinical case demonstrates the necessity to perform EEG as often as possible in children with critical illness; also we are stressing out the clinical usefulness in these cases of the somatosensory evoked potentials (SSEPs), which are independent of drug profile of intensive care and were proved decisive as a prognostic tool in these conditions. doi:10.1016/j.clinph.2019.04.394
P32-T Connecting technologies for protecting brains and saving futures—Aexey Ivanov *, Gabriel Variane (Neurosoft, Ivanovo, Russian Federation) ⇑
Corresponding author.
‘‘PBSF – Protecting brains & Saving Futures” – is a big national project in Brazil. The main goal of this project is to decrease infant mortality and increase quality of neonatal service not only in big cities, but also all over the country. Within this project, our international team designed specialized neonatal monitor, which contains cerebral oximeter ‘‘Medtronic INVOS 5100C” and cerebral function monitor ‘‘Neurosoft Neuromonitor”. Both of this combined systems now can work together and show both oxygen saturation and electrical activity of the brain on one screen as a trends. Now this project combine 14 hospitals in different parts of Brazil, where such combined monitors are installed. All this