Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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Evoked Potentials before the Intractable Epilepsy Surgery

난치성 뇌전증 환자에서 수술 전 유발전위검사

  • Lim, Sung Hyuk (Department of Neurology, Samsung Medical Center) ;
  • Park, Sang Ku (Department of Neurology, Samsung Medical Center) ;
  • Baek, Jae Seung (Department of Neurology, Samsung Medical Center) ;
  • Kim, Kab Kyu (Department of Neurology, Catholic University of Korea, Seoul St. Mary's Hospital) ;
  • Kim, Ki Eob (Department of Neurology, Korea University Anam Hospital) ;
  • Lee, Yu Ji (Department of Otolaryngology, Ehwa Womans University Seoul Hospital)
  • 임성혁 (삼성서울병원 신경과) ;
  • 박상구 (삼성서울병원 신경과) ;
  • 백재승 (삼성서울병원 신경과) ;
  • 김갑규 (가톨릭대학교 서울성모병원 신경과) ;
  • 김기업 (고려대학교병원 신경과) ;
  • 이유지 (이화여자대학교 서울병원 이비인후과)
  • Received : 2019.01.15
  • Accepted : 2019.03.13
  • Published : 2019.06.30
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Abstract

Various treatments can be attempted in patients with intractable epilepsy, in whom the symptoms of seizures are not controlled by various drugs. On the other hand, in patients requiring a surgical method, a preoperative examination is needed to determine the portion of seizure site to be resected. Electrodes are inserted into the cerebral cortex for accurate lesion measurements and safe operation. The electrodes inserted in the cortex not only record the electroencephalography (EEG), but also allow various tests to confirm the function of the part. One of these methods is the evoked potential test. From January 2015 to December 2018, the trends of measured waveforms in were analyzed 70 patients. The somatosensory evoked potential (SSEP) recorded on the electrode inserted in the cerebral cortex can be searched for the pathway of the central sulcus to avoid the primary motor area and primary sensory area. In addition, using the middle latency auditory evoked potentials (MLAEP) and flash visual evoked potentials (FVEP), the functional cortex in the auditory cortex and the visual cortex were compared with the seizure focus point on the EEG to help determine the location of the ablation and minimize functional impairment after surgery.

여러가지 약물에도 발작의 증세가 조절되지 않는 난치성 뇌전증 환자에서 다양한 치료법들을 시도해 볼 수 있다. 하지만 그 중 수술적인 방법이 필요한 환자에서는 수술 전 검사를 통해 발작부위의 절제부분을 결정한다. 정확한 병변의 측정과 안전한 수술을 위해 뇌 피질에 전극 삽입술을 시행한다. 피질에 삽입된 전극으로 단순히 뇌파만을 기록하는 것이 아니라 다양한 검사를 시도해 그 부위가 갖는 기능을 확인할 수 있고 그런 검사법 중 하나로 유발전위 검사법이 있다. 2015년 1월부터 2018년 12월까지 70명의 환자를 대상으로 측정된 파형의 경향이 의미하는 바를 분석하였다. 뇌 피질에 삽입된 전극에서 기록된 체성감각유발전위는 중심고랑의 주행경로를 찾아 일차운동영역 및 일차감각영역을 피해 수술 할 수 있다. 또한 청각유발전위와 시각유발전위를 이용해 청각피질과 시각피질에서 기능적 피질의 확인과 뇌파검사상 나타난 발작초점부위와의 관계를 비교해 절제부위를 결정하는데 도움을 주고 수술 후에 발생할 수 있는 기능적 장애를 최소화 할 수 있다.

Keywords

References

  1. Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, et al. Epileptic seizures and epilepsy: Definitions proposed by the international league against epilepsy (ilae) and the international bureau for epilepsy (ibe). Epilepsia. 2005;46:470-472. https://doi.org/10.1111/j.0013-9580.2005.66104.x
  2. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342:314-319. https://doi.org/10.1056/NEJM200002033420503
  3. Shorvon SD. The epidemiology and treatment of chronic and refractory epilepsy. Epilepsia. 1996;37(Suppl 2):1-3. https://doi.org/10.1111/j.1528-1157.1996.tb01812.x
  4. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol. 2002;59:205-210. https://doi.org/10.1001/archneur.59.2.205
  5. Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2005;76:534-539. https://doi.org/10.1136/jnnp.2004.041947
  6. Novy J, Logroscino G, Rossetti AO. Refractory status epilepticus:a prospective observational study. Epilepsia. 2010;51:251-256. https://doi.org/10.1111/j.1528-1167.2009.02323.x
  7. Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus:effect of treatment aggressiveness on prognosis. Arch Neurol. 2005;62:1698-1702. https://doi.org/10.1001/archneur.62.11.1698
  8. Betjemann JP, Josephson SA, Lowenstein DH, Burke JF. Trends in status epilepticus-related hospitalizations and mortality: redefined in US practice over time. JAMA Neurol. 2015;72:650-655. https://doi.org/10.1001/jamaneurol.2015.0188
  9. Engel J Jr, Shewmon DA. Overview: who should be considered a surgical candidate? In: Engel J Jr. Surgical treatment of the epilepsies. 2nd ed. New York: Raven Press; 1993. p23-34.
  10. ILAE Commission Report. The epidemiology of the epilepsies: future directions. Epilepsia. 1997;38:614-618. https://doi.org/10.1111/j.1528-1157.1997.tb01148.x
  11. Luders H, Lesser RP, Dinner DS, Morris HH, Wyllie E, Godoy J. Localization of cortical function: new information from extraoperative monitoring of patients with epilepsy. Epilepsia. 1988;29(Suppl 2):56-65. https://doi.org/10.1111/j.1528-1157.1988.tb05799.x
  12. Woolsey CN, Erickson TC, Gilson WE. Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg. 1979;51:476-506. https://doi.org/10.3171/jns.1979.51.4.0476
  13. Simon MV. Intraoperative neurophysiologic sensorimotor mapping-a review. J Neurol Neurophysiol. 2013;30:571-590. http://doi.org/10.4172/2155-9562.S3-002.
  14. Rowed DW, Houlden DA, Basavakumar DG. Somatosensory evoked potential identification of sensorimotor cortex in removal of intracranial neoplasms. Can J Neurol Sci. 1997;24:11-120.
  15. Goldring S. A method for surgical management of focal epilepsy, especially as it relates to children. J Neurosurg. 1978;49:344-356. https://doi.org/10.3171/jns.1978.49.3.0344
  16. Goldring S, Gregorie EM. Surgical management of epilepsy using epidural recordings to localize the seizure focus: review of 100 cases. J Neurosurg. 1984;60: 457-466. https://doi.org/10.3171/jns.1984.60.3.0457
  17. Lim SH, Park SK, Kim DJ, Baek JS, Park CW. Usefulness of direct cortical stimulation during intraoperative monitoring in patients with brain tumor near motor cortex. Korean J Clin Lab Sci. 2018;50:211-215. https://doi.org/10.15324/kjcls.2018.50.2.211
  18. Kalkman CJ, Traast H, Zuurmond WW, Bovill JG. Differential effects of propofol and nitrous oxide on posterior tibial nerve somatosensory cortical evoked potentials during alfentanil anaesthesia. Br J Anaesth. 1991;66:483-489. https://doi.org/10.1093/bja/66.4.483
  19. Kim LS, Boo SH. Auditory middle latency response. Korean J Audiol. 2001;5:27-35.
  20. Schwender D, Conzen P, Klasing S, Finsterer U, Poppel E, Peter K. The effects of anesthesia with increasing end-expiratory concentrations of sevoflurane on midlatency auditory evoked potentials. Anesth Analg. 1995;81:817-822. https://doi.org/10.1213/00000539-199510000-00027
  21. Schwender D, Klasing S, Madler C, Poppel E, Peter K. Mid-latency auditory evoked potentials during ketamine anaesthesia in humans. Br J Anaesth. 1993;71:629-632. https://doi.org/10.1093/bja/71.5.629
  22. Hayashi H, Kawaguchi M. Intraoperative monitoring of flash visual evoked potential under general anesthesia. Korean J Anesthesiol. 2017;70:127-135. https://doi.org/10.4097/kjae.2017.70.2.127
  23. Vega-Zelaya L, Pastor J. Intraoperative neurophysiological monitoring techniques for the resection of malignant brain tumors located in eloquent cortical areas. Austin J Neurosurg. 2015;2:1038.
  24. Ota T, Kawai K, Kamada K, Kin T, Saito N. Intraoperative monitoring of cortically recorded visual response for posterior visual pathway. J Neurosurg. 2010;112:285-94. https://doi.org/10.3171/2009.6.JNS081272
  25. Torres CV, Pastor J, Rocio E, Sola RG. Continuous monitoring of cortical visual evoked potentials by means of subdural electrodes in surgery on the posterior optic pathway. A case report and review of the literature. Rev Neurol. 2012;55:343-348. https://doi.org/10.33588/rn.5506.2012275
  26. Shin IY, Lim HJ, Lee JK, Kang JK, Lee SA, Ko TS. Clinical experiences with vagus nerve stimulation for medically intractable epilepsy. J Korean Epilepsy Soc. 2005;9:80-85.
  27. Shon YM. Deep brain stimulation for the treatment of medically intractable epilepsy: a review on clinical application. J Korean Epilepsy Soc. 2012;16:9-13.

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