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.
Keywords
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Article info
Publication history
Published online: October 08, 2008
Accepted:
July 28,
2008
Received in revised form:
July 12,
2008
Received:
May 9,
2008
Identification
Copyright
© 2008 Published by Elsevier Inc.
