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Original article| Volume 31, ISSUE 1, P34-41, January 2009

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Magnetoencephalography using total intravenous anesthesia in pediatric patients with intractable epilepsy: Lesional vs nonlesional epilepsy

  • Ayataka Fujimoto
    Affiliations
    The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8

    The Department of Neurosurgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
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  • Ayako Ochi
    Affiliations
    The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Katsumi Imai
    Affiliations
    The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Derrick Chan
    Affiliations
    The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Rohit Sharma
    Affiliations
    The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Amrita Viljoen
    Affiliations
    The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Bill Chu
    Affiliations
    The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Stephanie Holowka
    Affiliations
    Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Sheelagh M. Kemp
    Affiliations
    Department of Anesthesiology, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Sylvester H. Chuang
    Affiliations
    Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Akira Matsumura
    Affiliations
    The Department of Neurosurgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
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  • Satoshi Ayuzawa
    Affiliations
    The Department of Neurosurgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
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  • O. Carter Snead III
    Affiliations
    The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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  • Hiroshi Otsubo
    Correspondence
    Corresponding author. Address: The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ont., Canada M5G 1X8. Tel.: +1 416 813 6295; fax: +1 416 813 6334.
    Affiliations
    The Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ont., Canada M5G 1X8
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      Abstract

      Purpose: Magnetoencephalography (MEG) provides source localization of interictal spikes. We use total intravenous anesthesia (TIVA) with propofol to immobilize uncooperative children. We evaluate the effect of TIVA on interictal spikes in children who have intractable epilepsy with or without MRI lesions. Methods: We studied 28 children (3–14 years; mean, 6.6). We intravenously administered propofol (30–60 μg/kg/min) to record MEG with simultaneous EEG. We evaluated MEG spike sources (MEGSSs). We compared spikes on simultaneous EEG under TIVA with those on scalp video-EEG without TIVA. Results: There was a significant decrease in frequent spikes (10 patients, 36%) on simultaneous EEG under TIVA compared to those (22 patients, 79%) on scalp video-EEG without TIVA (P < 0.01). MEGSSs were present in 21 (75%) of 28 patients. Clustered MEGSSs occurred in 15 (83%) of 18 lesional patients but in 3 (30%) of 10 nonlesional patients (P < 0.05). MEGSSs were more frequently absent in nonlesional (6 patients, 60%) than lesional (one patient, 5%) patients (P < 0.01). Thirteen patients with MRI and/or histopathologically confirmed neuronal migration disorder most frequently showed clustered MEGSSs (11 patients, 85%) compared to those of other lesional and nonlesional patients. Conclusion: Propofol-based TIVA reduced interictal spikes on simultaneous EEG. TIVA for MEG still had utility in identifying spike sources in a subset of pediatric patients with intractable epilepsy who were uncooperative and surgical candidates. In lesional patients, MEG under TIVA frequently localized the clustered MEGSSs. Neuronal migration disorders were intrinsically epileptogenic and produced clustered MEGSSs under TIVA. Nonlesional patients often had no MEGSS under TIVA.

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