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The application of chronic cerebellar stimulation for intractable epilepsy
S158
Stereotactic and Functional Neurosurgery- Epilepsy
acceptedworld-widefor the surgicalmanagementof pain.However, the indicationsare notundisputed,andtechnicalproblemshaveoftenbeendescribed. The presentprospectivestudy aims atdetermining whether'Dual-Lead' systems can (1st)inNuencechronicaxial pain, and (2nd) reduce thefrequencyof surgical revisions for correction of lead migration. Materials and Methods: A pilot study was performed using a radio fre11 casessinceAugust1995. Indications quencycontrolled'Dual-Lead' systemin were: "radicular lumbar syndrome" (n=5), "pseudoradicular lumbar syndrome" (n =3), "radicular cerv icobrachialgia " (n=2), and"endangitisobliterans"(n =1). Contraindicationswere: possibility of causal therapy, negativeexperiencewith TENS, failure of teststimulation, and malignancy-relatedpain. Assessmentof thetherapeuticresultwasbasedon clinical findings, painevaluation(visualanalogue scale), andpostoperativestate ascomparedto thepreoperativesituation (multimodaloutcomescale). Preliminary Results: Seven patientshad a 60% relief ofradicularpain as determined by the VAS score 1 year following surgery. Only 5 patientshad a sufficientparaesthesiaoverlapof the axial component.Motordeficitscouldnot be influenced by theintervention . The analysis of the pre- and postoperative consumptionof analgesicsrevealed a statisticallysignificantdecrease (p < 0.001 Wilcoxonrank test). There was one case of electrodedislocation,which requiredsurgicalrevisiontoregainoptimalparaesthesiacoverage.Twopatients developeda transientseromaat the area of thereceiver. Onepatientdeveloped stimulation-relatedspellsofdizziness. Discussion/Conclusions: Experience gained thus far indicatesthat implantation of SCSdual-channelsystemswith thecombinationstheyofferexerts a positive influence on low back pain and motility disturbances , althoughthe maximumeffect is achievedin theextremities. Thepatient'sinteractionwith the towardscognitive andbehavioral stimulationprogramscontributesconsiderably paincontrol.
IP-S-S8? 1 Treatment of central pain due to brain edema by activatingblood circulationand eliminatingblood stasis: Asummaryof ten cases
JiangShanLi. Dept. ofNeurosurgery,People'sHospital of HuangJiangTown, DongGuan City, China Central pain due to braintrauma does not occur infrequently . The diagnosisof theconditionmaybeobscuredby paralysis andparesthesias. The ten patients withposttraumaticcentralpain,reportedhere, weretreatedwith acombination of traditional Chinese and Westemmedicines. The diagnosisandtreatmentof thisconditionwill be discussed.
Tuesday, 8 July 1997 Discussion: In our experiencespike-topograms evaluatinginterictalepileptiform activityareof highvaluefor localizing the zoneof seizureorigin. Analysis of differentparametersof spike-topogramsas performedin this study does not allowpredictionof seizure -outcome.
I P-S-S89I A variant ofstereotacticcallosotomy E. Zboi'ilova, J. Chrastina,Z. Novak, P. Nadvomlk. Opt. ofNeurosurgery, FacultyHospital Bmo, Czech RepUblic Callosotomyperformedusing the classical neurosurgicaltechniqueis a rather demandingoperation.This was the reasonwhy the authors developedan original and simplemethodof corpuscallosum transsection employing a push-out probe, basedonRiechert-Mundinger's string electrode. Rotation of the probe in consecutive targets in the corpus callosumtranssects thisstructurecompletelyin the extent required, because there is partial overlapping of the circles of probe rotation. Patients were referred for surgery fromthe CenterforEpilepsy, FacultyHospital "SI. Ann" Brno. This methodwas usedin 4patients.Clinicaland MRI results wereevaluatedas satisfactory . Stereotacticprocedures in the corpuscallosum area have been already performedto a limited extent but the proposed surgical procedure enables fluenttransssctionof thisstructurein the extentrequired.
IP-S-S90 I The applicationof chroniccerebellarstimulationfor intractableepilepsy Tan Oi-fu, ZhuZheng-Xiang, Sun Ke-hua, Pan Yuxi.Dept. of Neurosurgery, Nanjing Jinling Hospital Nanjing, 210002, PR China We havedevelopeda cerebelar stimulator device which consists of a transmitter, a receiver and a pair of elec trodes. The receiver was placed in the subclavicularfossa Chroniccerebellarstimulation wasperformed in 15 palients suffering from epilepsy(9 malesand 6females), rangingin age from 12 10 33 years (mean 20years), the averagedurationof epileptichistory was 8.9 years. Thesepatientshadbeen treated unsuccessfullywith AEDs. The postoperativefollow-uprangedfrom 1 to 4 years, with a mean of 2 years. The clinical examination hasshown thatchronic cerebellarstimulationcan giveimprovement of EEG, a-wave retumed tonormal, epileptiformwaves arereduced or disappear, visualevokedpotential(VEP) abolished, HIM ratio reduced, H-wave amplitudereduced, incubation period prolonged. Six patientsare seizure-free, 5 casesmarkedlyreduced, 3 patientsreduced, 1 case noimprovement. In this paper, weanalyzed defectivecauses of thecerebellarstimulationsystem and proposemeasuresof improvement.
IP-S-S91 I A comparative pilot-stUdy of the long term Tuesday, 8July1997
14:00-16:15
P-3 Stereotacticand Functional Neurosurgery- Epilepsy
IP-S-S88I the Relev~nce of sp.ike-topograms for the definitionof epIleptogenicarea
tolerabilityof valproate andphenytoinas anticonvulsiveprophylaxisafter electivecraniotomy
L.F.M. Beenen 1 , HAM. van Alphen' , J.J.Heimans2, D.GA Kasteleijn-Nols t Trenite3, F.J. Lindeboom4, J. Snoek4 . 1 Dept. ofNeurosurgery,University Hospital VnjeUniversiteit , Amsterdam, TheNetherlands,2 Dept. of Neurology, University Hospitat Vrije Universiteit, Amsterdam, The Netherlands,3 Stichting Instituutvoor EpilepsieBestrijding "Meer en Bosch", Heemstede, The Netherlands, 4 Dept. of Medical Psychology, University Hospital Vrije Universiteit,Amsterdam,The Netherlands
The risk of epileptic seizures after craniotomy is about 20%. Nevertheless, the prophylacticuse of anticonvulsive medication after elective neurosurgical proceduresis stillcontroversial. If anti-convulsantsareprescribed, the choiceof O. Schijns1.2 , A. Hufnagel2 , J. Zentner' , J.Schramm' .' Dept. of Neurothedruganditsdosageareoften based on tradition. An appropriatecomparison logy, University of Bonn, Bonn, Germany surgery,2 Dept. of Epilepto of theeffectsandadverse effectsof different drugs has neverbeen made. Theaim of this studyis tovestigatethecognitivefunctioning in andthe "qualIntroduction:The significanceof interictalactivity for theoutcomeafter resecity of live" for the period of one year aftercraniotomyin patientsusing one of tiveepilepsy surgicalproceduresis still debated controversely . Spike-topograms twonowadayscommonlyappliedanti-convulsants: phenytoinandvalproate. A haveprovento be a valuabletoolfor quantificationepileptiform of activity.Thereprospective,stratified,randomized, do uble-blindpilot-studywasdesigned,cornfore, this study was designedto examine the significanceof quanti ficationof -topogramsfor predictionof seizure-outcome . paring twogroupsof 50 patients each, who were treated either with phenytoin imerictalactivitybymeansof spike or withvalproate(Depakine Chrono" Sanefi·Winthrop v.o.f.). The patients, who MethodS:Spike-topogramswere performedin a total of 32patients with fulfilled all inclusion criteria and had none of the exclusion criteria. were, after temporal (n=24) and extratemporal(n =8) epilepsies.There were 20 males pathology(tumour, informedconsent, stratified according to their intracranial and 12females with ages ranging from 3 to 55 years (mean-age: 28 years). All patients receivedsubduralgrid and stripelectrodes. For everyelectrode trauma, vascularlesion) and includedin one of the twotreatmentgroups. At 6 contact, amplitudes and latencies of interictal spikes were quantElectro ified. weeks, 3months, 6 monthsand 1 year after surgeryall patients were checked physiological data were correlatedwith the volume ofesectionas r determined on neurological statusand epileptic events. Also at fixed intervals standardized bypostoperativeMRIscans. For statistical analysis the Fisher'sExactTestwas neuropsycholog ical testsand questionnaires on cognitive functioningand quality of life were performed.At the sametimeplasmalevelsofthe anti-convulsants used. Results: On the basis of an acceptable delay of spikes from the earliest weredetermined. spikes in themain-clusterof up to 10 ms, we found that the extentof resection At theclosing-datefor submission of abstracts, the inclusionand follow-up did notallow predictionofseizure-outcome.Moreover,lateralization,localization of allpatientswerecompleted. Because the datamanagementwas not comand numberofspike-clustersdid notcorrelatewithseizure-outcome.However, pletelyfinishedat thattime, thedouble-blinocodewas notbrokenyet. The final localization of the earliestand highestspikesallowedidentificationof the zone resultsof this studywill be presentedduring the11th InternationalCongressof of seizureonset in 80% of the patients. NeurologicalSurgery.
Stereotactic and Functional Neurosurgery- Epilepsy
acceptedworld-widefor the surgicalmanagementof pain.However, the indicationsare notundisputed,andtechnicalproblemshaveoftenbeendescribed. The presentprospectivestudy aims atdetermining whether'Dual-Lead' systems can (1st)inNuencechronicaxial pain, and (2nd) reduce thefrequencyof surgical revisions for correction of lead migration. Materials and Methods: A pilot study was performed using a radio fre11 casessinceAugust1995. Indications quencycontrolled'Dual-Lead' systemin were: "radicular lumbar syndrome" (n=5), "pseudoradicular lumbar syndrome" (n =3), "radicular cerv icobrachialgia " (n=2), and"endangitisobliterans"(n =1). Contraindicationswere: possibility of causal therapy, negativeexperiencewith TENS, failure of teststimulation, and malignancy-relatedpain. Assessmentof thetherapeuticresultwasbasedon clinical findings, painevaluation(visualanalogue scale), andpostoperativestate ascomparedto thepreoperativesituation (multimodaloutcomescale). Preliminary Results: Seven patientshad a 60% relief ofradicularpain as determined by the VAS score 1 year following surgery. Only 5 patientshad a sufficientparaesthesiaoverlapof the axial component.Motordeficitscouldnot be influenced by theintervention . The analysis of the pre- and postoperative consumptionof analgesicsrevealed a statisticallysignificantdecrease (p < 0.001 Wilcoxonrank test). There was one case of electrodedislocation,which requiredsurgicalrevisiontoregainoptimalparaesthesiacoverage.Twopatients developeda transientseromaat the area of thereceiver. Onepatientdeveloped stimulation-relatedspellsofdizziness. Discussion/Conclusions: Experience gained thus far indicatesthat implantation of SCSdual-channelsystemswith thecombinationstheyofferexerts a positive influence on low back pain and motility disturbances , althoughthe maximumeffect is achievedin theextremities. Thepatient'sinteractionwith the towardscognitive andbehavioral stimulationprogramscontributesconsiderably paincontrol.
IP-S-S8? 1 Treatment of central pain due to brain edema by activatingblood circulationand eliminatingblood stasis: Asummaryof ten cases
JiangShanLi. Dept. ofNeurosurgery,People'sHospital of HuangJiangTown, DongGuan City, China Central pain due to braintrauma does not occur infrequently . The diagnosisof theconditionmaybeobscuredby paralysis andparesthesias. The ten patients withposttraumaticcentralpain,reportedhere, weretreatedwith acombination of traditional Chinese and Westemmedicines. The diagnosisandtreatmentof thisconditionwill be discussed.
Tuesday, 8 July 1997 Discussion: In our experiencespike-topograms evaluatinginterictalepileptiform activityareof highvaluefor localizing the zoneof seizureorigin. Analysis of differentparametersof spike-topogramsas performedin this study does not allowpredictionof seizure -outcome.
I P-S-S89I A variant ofstereotacticcallosotomy E. Zboi'ilova, J. Chrastina,Z. Novak, P. Nadvomlk. Opt. ofNeurosurgery, FacultyHospital Bmo, Czech RepUblic Callosotomyperformedusing the classical neurosurgicaltechniqueis a rather demandingoperation.This was the reasonwhy the authors developedan original and simplemethodof corpuscallosum transsection employing a push-out probe, basedonRiechert-Mundinger's string electrode. Rotation of the probe in consecutive targets in the corpus callosumtranssects thisstructurecompletelyin the extent required, because there is partial overlapping of the circles of probe rotation. Patients were referred for surgery fromthe CenterforEpilepsy, FacultyHospital "SI. Ann" Brno. This methodwas usedin 4patients.Clinicaland MRI results wereevaluatedas satisfactory . Stereotacticprocedures in the corpuscallosum area have been already performedto a limited extent but the proposed surgical procedure enables fluenttransssctionof thisstructurein the extentrequired.
IP-S-S90 I The applicationof chroniccerebellarstimulationfor intractableepilepsy Tan Oi-fu, ZhuZheng-Xiang, Sun Ke-hua, Pan Yuxi.Dept. of Neurosurgery, Nanjing Jinling Hospital Nanjing, 210002, PR China We havedevelopeda cerebelar stimulator device which consists of a transmitter, a receiver and a pair of elec trodes. The receiver was placed in the subclavicularfossa Chroniccerebellarstimulation wasperformed in 15 palients suffering from epilepsy(9 malesand 6females), rangingin age from 12 10 33 years (mean 20years), the averagedurationof epileptichistory was 8.9 years. Thesepatientshadbeen treated unsuccessfullywith AEDs. The postoperativefollow-uprangedfrom 1 to 4 years, with a mean of 2 years. The clinical examination hasshown thatchronic cerebellarstimulationcan giveimprovement of EEG, a-wave retumed tonormal, epileptiformwaves arereduced or disappear, visualevokedpotential(VEP) abolished, HIM ratio reduced, H-wave amplitudereduced, incubation period prolonged. Six patientsare seizure-free, 5 casesmarkedlyreduced, 3 patientsreduced, 1 case noimprovement. In this paper, weanalyzed defectivecauses of thecerebellarstimulationsystem and proposemeasuresof improvement.
IP-S-S91 I A comparative pilot-stUdy of the long term Tuesday, 8July1997
14:00-16:15
P-3 Stereotacticand Functional Neurosurgery- Epilepsy
IP-S-S88I the Relev~nce of sp.ike-topograms for the definitionof epIleptogenicarea
tolerabilityof valproate andphenytoinas anticonvulsiveprophylaxisafter electivecraniotomy
L.F.M. Beenen 1 , HAM. van Alphen' , J.J.Heimans2, D.GA Kasteleijn-Nols t Trenite3, F.J. Lindeboom4, J. Snoek4 . 1 Dept. ofNeurosurgery,University Hospital VnjeUniversiteit , Amsterdam, TheNetherlands,2 Dept. of Neurology, University Hospitat Vrije Universiteit, Amsterdam, The Netherlands,3 Stichting Instituutvoor EpilepsieBestrijding "Meer en Bosch", Heemstede, The Netherlands, 4 Dept. of Medical Psychology, University Hospital Vrije Universiteit,Amsterdam,The Netherlands
The risk of epileptic seizures after craniotomy is about 20%. Nevertheless, the prophylacticuse of anticonvulsive medication after elective neurosurgical proceduresis stillcontroversial. If anti-convulsantsareprescribed, the choiceof O. Schijns1.2 , A. Hufnagel2 , J. Zentner' , J.Schramm' .' Dept. of Neurothedruganditsdosageareoften based on tradition. An appropriatecomparison logy, University of Bonn, Bonn, Germany surgery,2 Dept. of Epilepto of theeffectsandadverse effectsof different drugs has neverbeen made. Theaim of this studyis tovestigatethecognitivefunctioning in andthe "qualIntroduction:The significanceof interictalactivity for theoutcomeafter resecity of live" for the period of one year aftercraniotomyin patientsusing one of tiveepilepsy surgicalproceduresis still debated controversely . Spike-topograms twonowadayscommonlyappliedanti-convulsants: phenytoinandvalproate. A haveprovento be a valuabletoolfor quantificationepileptiform of activity.Thereprospective,stratified,randomized, do uble-blindpilot-studywasdesigned,cornfore, this study was designedto examine the significanceof quanti ficationof -topogramsfor predictionof seizure-outcome . paring twogroupsof 50 patients each, who were treated either with phenytoin imerictalactivitybymeansof spike or withvalproate(Depakine Chrono" Sanefi·Winthrop v.o.f.). The patients, who MethodS:Spike-topogramswere performedin a total of 32patients with fulfilled all inclusion criteria and had none of the exclusion criteria. were, after temporal (n=24) and extratemporal(n =8) epilepsies.There were 20 males pathology(tumour, informedconsent, stratified according to their intracranial and 12females with ages ranging from 3 to 55 years (mean-age: 28 years). All patients receivedsubduralgrid and stripelectrodes. For everyelectrode trauma, vascularlesion) and includedin one of the twotreatmentgroups. At 6 contact, amplitudes and latencies of interictal spikes were quantElectro ified. weeks, 3months, 6 monthsand 1 year after surgeryall patients were checked physiological data were correlatedwith the volume ofesectionas r determined on neurological statusand epileptic events. Also at fixed intervals standardized bypostoperativeMRIscans. For statistical analysis the Fisher'sExactTestwas neuropsycholog ical testsand questionnaires on cognitive functioningand quality of life were performed.At the sametimeplasmalevelsofthe anti-convulsants used. Results: On the basis of an acceptable delay of spikes from the earliest weredetermined. spikes in themain-clusterof up to 10 ms, we found that the extentof resection At theclosing-datefor submission of abstracts, the inclusionand follow-up did notallow predictionofseizure-outcome.Moreover,lateralization,localization of allpatientswerecompleted. Because the datamanagementwas not comand numberofspike-clustersdid notcorrelatewithseizure-outcome.However, pletelyfinishedat thattime, thedouble-blinocodewas notbrokenyet. The final localization of the earliestand highestspikesallowedidentificationof the zone resultsof this studywill be presentedduring the11th InternationalCongressof of seizureonset in 80% of the patients. NeurologicalSurgery.