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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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      References

        • Ebrahim Z.Y.
        • Schubert A.
        • Van Ness P.
        • Wolgamuth B.
        • Awad I.
        The effect of propofol on the electroencephalogram of patients with epilepsy.
        Anesth Analg. 1994; 78: 275-279
        • Laguna J.F.
        • Korein J.
        Diagnostic value of diazepam in electroencephalography.
        Arch Neurol. 1972; 26: 265-272
        • Browne T.R.
        Clonazepam. A review of a new anticonvulsant drug.
        Arch Neurol. 1976; 33: 326-332
        • Szmuk P.
        • Kee S.
        • Pivalizza E.G.
        • Warters R.D.
        • Abramson D.C.
        • Ezri T.
        Anaesthesia for magnetoencephalography in children with intractable seizures.
        Paediatr Anaesth. 2003; 13: 811-817
        • Balakrishnan G.
        • Grover K.M.
        • Mason K.
        • Smith B.
        • Barkley G.L.
        • Tepley N.
        • et al.
        A retrospective analysis of the effect of general anesthetics on the successful detection of interictal epileptiform activity in magnetoencephalography.
        Anesth Analg. 2007; 104: 1493-1497
        • Otsubo H.
        • Ochi A.
        • Elliott I.
        • Chuang S.H.
        • Rutka J.T.
        • Jay V.
        • et al.
        MEG predicts epileptic zone in lesional extrahippocampal epilepsy: 12 pediatric surgery cases.
        Epilepsia. 2001; 42: 1523-1530
        • Iida K.
        • Otsubo H.
        • Matsumoto Y.
        • Ochi A.
        • Oishi M.
        • Holowka S.
        • et al.
        Characterizing magnetic spike sources by using magnetoencephalography-guided neuronavigation in epilepsy surgery in pediatric patients.
        J Neurosurg. 2005; 102: 187-196
        • Palmini A.
        • Gambardella A.
        • Andermann F.
        • Dubeau F.
        • da Costa J.C.
        • Olivier A.
        • et al.
        Intrinsic epileptogenicity of human dysplastic cortex as suggested by corticography and surgical results.
        Ann Neurol. 1995; 37: 476-487
        • Otsubo H.
        • Iida K.
        • Okuda C.
        • Ochi A.
        • Pang E.
        • Weiss S.K.
        • et al.
        Neurophysiological findings of neuronal migration disorders: intrinsic epileptogenicity of focal cortical dysplasia on EEG, ECoG, and MEG.
        J Child Neurol. 2005; 20: 357-363
        • Otsubo H.
        • Imai K.
        Clinical neurophysiology of cortical malformations: magnetoencephalography and electroencephalography.
        in: Sarnet H.B. Curatolo P. Malformation of the nervous system, handbook of clinical neurology. vol. 87. Elsevier Ltd., Edinburgh2007: 503-516
        • Cohen-Gadol A.A.
        • Wilhelmi B.G.
        • Collignon F.
        • White J.B.
        • Britton J.W.
        • Cambier D.M.
        • et al.
        Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis.
        J Neurosurg. 2006; 104: 513-524
        • RamachandranNair R.
        • Otsubo H.
        • Shroff M.M.
        • Ochi A.
        • Weiss S.K.
        • Rutka J.T.
        • et al.
        MEG predicts outcome following surgery for intractable epilepsy in children with normal or nonfocal MRI findings.
        Epilepsia. 2007; 48: 149-157
        • Zifkin B.G.
        • Cracco R.O.
        An orderly approach to the abnormal electroencephalogram.
        in: Ebersole J.S. Pedley T.A. Current practice of clinical electroencephalography. 3rd ed. Lippincott Williams & Wilkins, Philadelphia2002: 288-302
        • Meyer S.
        • Shamdeen M.G.
        • Kegel B.
        • Mencke T.
        • Gottschling S.
        • Gortner L.
        • et al.
        Effect of propofol on seizure-like phenomena and electroencephalographic activity in children with epilepsy vs children with learning difficulties.
        Anaesthesia. 2006; 61: 1040-1047
        • Bercovici E.
        • Pang E.W.
        • Sharma R.
        • Mohamed I.S.
        • Imai K.
        • Fujimoto A.
        • et al.
        Somatosensory evoked fields on magnetoencephalography for epilepsy infants younger than four years with total intravenous anesthesia.
        Clin Neurophysiol. 2008; 119: 1328-1334
        • van Gestel J.P.
        • Blusse van Oud-Alblas H.J.
        • Malingre M.
        • Ververs F.F.
        • Braun K.P.
        • van Nieuwenhuizen O.
        Propofol and thiopental for refractory status epilepticus in children.
        Neurology. 2005; 65: 591-592
        • Rossetti A.O.
        • Reichhart M.D.
        • Schaller M.D.
        • Despland P.A.
        • Bogousslavsky J.
        Propofol treatment of refractory status epilepticus: a study of 31 episodes.
        Epilepsia. 2004; 45: 757-763
        • Hales T.G.
        • Lambert J.J.
        The actions of propofol on inhibitory amino acid receptors of bovine adrenomedullary chromaffin cells and rodent central neurons.
        Br J Pharmacol. 1991; 104: 619-628
        • Hara M.
        • Kai Y.
        • Ikemoto Y.
        Propofol activates GABAA receptor-chloride ionophore complex in dissociated hippocampal pyramidal neurons of the rat.
        Anesthesiology. 1993; 79: 781-788
        • Orser B.A.
        • Wang L.Y.
        • Pennefather P.S.
        • MacDonald J.F.
        Propofol modulates activation and desensitization of GABAA receptors in cultured murine hippocampal neurons.
        J Neurosci. 1994; 14: 7747-7760
        • Peduto V.A.
        • Concas A.
        • Santoro G.
        • Biggio G.
        • Gessa G.L.
        Biochemical and electrophysiologic evidence that propofol enhances GABAergic transmission in the rat brain.
        Anesthesiology. 1991; 75: 1000-1009
        • Orser B.A.
        • Bertlik M.
        • Wang L.Y.
        • MacDonald J.F.
        Inhibition by propofol (2,6 di-isopropylphenol) of the N-methyl-d-aspartate subtype of glutamate receptor in cultured hippocampal neurones.
        Br J Pharmacol. 1995; 116: 1761-1768
        • Yamakura T.
        • Sakimura K.
        • Shimoji K.
        • Mishina M.
        Effects of propofol on various AMPA-, kainate- and NMDA-selective glutamate receptor channels expressed in Xenopus oocytes.
        Neurosci Lett. 1995; 188: 187-190
        • Rehberg B.
        • Duch D.S.
        Suppression of central nervous system sodium channels by propofol.
        Anesthesiology. 1999; 91: 512-520
        • Inoue Y.
        • Shibuya I.
        • Kabashima N.
        • Noguchi J.
        • Harayama N.
        • Ueta Y.
        • et al.
        ; The mechanism of inhibitory actions of propofol on rat supraoptic neurons.
        Anesthesiology. 1999; 91: 167-178
        • Iwasaki M.
        • Pestana E.
        • Burgess R.C.
        • Lüders H.O.
        • Shamoto H.
        • Nakasato N.
        Detection of epileptiform activity by human interpreters: blinded comparison between electroencephalography and magnetoencephalography.
        Epilepsia. 2005; 46: 59-68
        • Paulini A.
        • Fischer M.
        • Rampp S.
        • Scheler G.
        • Hopfengärtner R.
        • Kaltenhäuser M.
        • et al.
        Lobar localization information in epilepsy patients: MEG – A useful tool in routine presurgical diagnosis.
        Epilepsy Res. 2007; 76: 124-130
        • Merlet I.
        • Paetau R.
        • García-Larrea L.
        • Uutela K.
        • Granström M.L.
        • Mauguiere F.
        Apparent asynchrony between interictal electric and magnetic spikes.
        Neuroreport. 1997; 8: 1071-1076
        • Cooper R.
        • Winter A.L.
        • Crow H.J.
        • Walter W.G.
        Comparison of subcortical, cortical and scalp activity using chronically indwelling electrodes in man.
        Electroencephalogr Clin Neurophysiol. 1965; 18: 217-228
        • Tao J.X.
        • Ray A.
        • Hawes-Ebersole S.
        • Ebersole J.S.
        Intracranial EEG substrates of scalp EEG interictal spikes.
        Epilepsia. 2005; 46: 669-676
        • Oishi M.
        • Otsubo H.
        • Kameyama S.
        • Morota N.
        • Masuda H.
        • Kitayama M.
        • et al.
        Epileptic spikes: magnetoencephalography versus simultaneous electrocorticography.
        Epilepsia. 2002; 43: 1390-1395
        • Mikuni N.
        • Nagamine T.
        • Ikeda A.
        • Terada K.
        • Taki W.
        • Kimura J.
        • et al.
        Simultaneous recording of epileptiform discharges by MEG and subdural electrodes in temporal lobe epilepsy.
        Neuroimage. 1997; 5: 298-306
        • Otsubo H.
        • Iida K.
        • Oishi M.
        • Okuda C.
        • Ochi A.
        • Pang E.
        • et al.
        Neurophysiologic findings of neuronal migration disorders: intrinsic epileptogenicity of focal cortical dysplasia on electroencephalography, electrocorticography, and magnetoencephalography.
        J Child Neurol. 2005; 20: 357-363
        • Park H.M.
        • Nakasato N.
        • Iwasaki M.
        • Shamoto H.
        • Tominaga T.
        • Yoshimoto T.
        Comparison of magnetoencephalographic spikes with and without concurrent electroencephalographic spikes in extratemporal epilepsy.
        Tohoku J Exp Med. 2004; 203: 165-174
        • Calcagnotto M.E.
        • Paredes M.F.
        • Tihan T.
        • Barbaro N.M.
        • Baraban S.C.
        Dysfunction of synaptic inhibition in epilepsy associated with focal cortical dysplasia.
        J Neurosci. 2005; 25: 9649-9657
        • Tassi L.
        • Colombo N.
        • Garbelli R.
        • Francione S.
        • Lo Russo G.
        • Mai R.
        • et al.
        Focal cortical dysplasia: neuropathological subtypes, EEG, neuroimaging and surgical outcome.
        Brain. 2002; 125: 1719-1732