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Reorganization and stability for motor and language areas using cortical stimulation: case example and review of the literature.

Serafini S, Komisarow JM, Gallentine W, Mikati MA, Bonner MJ, Kranz PG, Haglund MM, Grant G - Brain Sci (2013)

Bottom Line: The clinical history and extensive workup prior to surgery is discussed as well as the opportunity to compare the cortical maps for language, motor, and sensory function before each resection.Detailed neuropsychological data is presented before and after any surgical intervention to hypothesize about the extent of reorganization between epochs.We conclude that intrahemispheric cortical plasticity does occur following frontal lobe resective surgery in a teenager with medically refractory seizures.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA. sandra.serafini@dm.duke.edu.

ABSTRACT
The cerebral organization of language in epilepsy patients has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping and more recently with noninvasive neuroimaging techniques, such as functional MRI. In the setting of a chronic seizure disorder, clinical variables have been shown to contribute to cerebral language reorganization underscoring the need for language lateralization and localization procedures. We present a 14-year-old pediatric patient with a refractory epilepsy disorder who underwent two neurosurgical resections of a left frontal epileptic focus separated by a year. He was mapped extraoperatively through a subdural grid using cortical stimulation to preserve motor and language functions. The clinical history and extensive workup prior to surgery is discussed as well as the opportunity to compare the cortical maps for language, motor, and sensory function before each resection. Reorganization in cortical tongue sensory areas was seen concomitant with a new zone of ictal and interictal activity in the previous tongue sensory area. Detailed neuropsychological data is presented before and after any surgical intervention to hypothesize about the extent of reorganization between epochs. We conclude that intrahemispheric cortical plasticity does occur following frontal lobe resective surgery in a teenager with medically refractory seizures.

No MeSH data available.


Related in: MedlinePlus

Subdural grid EEG of grid columns 1–5 prior to second resection showing left frontal seizure activity with diffuse onset at contacts 13–14, 21–22, 29–30, 37–38, characterized by rhythmic spike and slow wave activity. See bottom right for µV/time reference.
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brainsci-03-01597-f007: Subdural grid EEG of grid columns 1–5 prior to second resection showing left frontal seizure activity with diffuse onset at contacts 13–14, 21–22, 29–30, 37–38, characterized by rhythmic spike and slow wave activity. See bottom right for µV/time reference.

Mentions: The patient was seizure free for four months post-operatively. At five months post-operatively, the patient had a cluster of breakthrough seizures. An EEG performed at this time demonstrated frequent generalized spike and wave discharges originating from the left hemisphere and left-hemisphere slowing. Ten months postoperatively at the age of 13, the patient underwent additional workup which led to the hypothesis that the seizures were still originating from the left frontal region, with no suggestion of temporal onset. Repeat surgery was recommended and a 6 × 8 (48-contact) frontotemporal grid was implanted for seizure localization and extraoperative mapping. ECoG showed a diffuse seizure onset starting with rhythmic spike and slow wave activity covering contacts 13–14, 21–22, 29–30, 37–38 and at the depth electrode just posterior to the prior resection (Figure 7). Electrode placement and documentation are as described above and can be seen in Figure 8A–C, with a post-resection image in Figure 8D.


Reorganization and stability for motor and language areas using cortical stimulation: case example and review of the literature.

Serafini S, Komisarow JM, Gallentine W, Mikati MA, Bonner MJ, Kranz PG, Haglund MM, Grant G - Brain Sci (2013)

Subdural grid EEG of grid columns 1–5 prior to second resection showing left frontal seizure activity with diffuse onset at contacts 13–14, 21–22, 29–30, 37–38, characterized by rhythmic spike and slow wave activity. See bottom right for µV/time reference.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061887&req=5

brainsci-03-01597-f007: Subdural grid EEG of grid columns 1–5 prior to second resection showing left frontal seizure activity with diffuse onset at contacts 13–14, 21–22, 29–30, 37–38, characterized by rhythmic spike and slow wave activity. See bottom right for µV/time reference.
Mentions: The patient was seizure free for four months post-operatively. At five months post-operatively, the patient had a cluster of breakthrough seizures. An EEG performed at this time demonstrated frequent generalized spike and wave discharges originating from the left hemisphere and left-hemisphere slowing. Ten months postoperatively at the age of 13, the patient underwent additional workup which led to the hypothesis that the seizures were still originating from the left frontal region, with no suggestion of temporal onset. Repeat surgery was recommended and a 6 × 8 (48-contact) frontotemporal grid was implanted for seizure localization and extraoperative mapping. ECoG showed a diffuse seizure onset starting with rhythmic spike and slow wave activity covering contacts 13–14, 21–22, 29–30, 37–38 and at the depth electrode just posterior to the prior resection (Figure 7). Electrode placement and documentation are as described above and can be seen in Figure 8A–C, with a post-resection image in Figure 8D.

Bottom Line: The clinical history and extensive workup prior to surgery is discussed as well as the opportunity to compare the cortical maps for language, motor, and sensory function before each resection.Detailed neuropsychological data is presented before and after any surgical intervention to hypothesize about the extent of reorganization between epochs.We conclude that intrahemispheric cortical plasticity does occur following frontal lobe resective surgery in a teenager with medically refractory seizures.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA. sandra.serafini@dm.duke.edu.

ABSTRACT
The cerebral organization of language in epilepsy patients has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping and more recently with noninvasive neuroimaging techniques, such as functional MRI. In the setting of a chronic seizure disorder, clinical variables have been shown to contribute to cerebral language reorganization underscoring the need for language lateralization and localization procedures. We present a 14-year-old pediatric patient with a refractory epilepsy disorder who underwent two neurosurgical resections of a left frontal epileptic focus separated by a year. He was mapped extraoperatively through a subdural grid using cortical stimulation to preserve motor and language functions. The clinical history and extensive workup prior to surgery is discussed as well as the opportunity to compare the cortical maps for language, motor, and sensory function before each resection. Reorganization in cortical tongue sensory areas was seen concomitant with a new zone of ictal and interictal activity in the previous tongue sensory area. Detailed neuropsychological data is presented before and after any surgical intervention to hypothesize about the extent of reorganization between epochs. We conclude that intrahemispheric cortical plasticity does occur following frontal lobe resective surgery in a teenager with medically refractory seizures.

No MeSH data available.


Related in: MedlinePlus