Factors that modify the risk of intraoperative seizures triggered by electrical stimulation during supratentorial functional mapping. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Dineen, Jennifer; Maus, Douglas C.; Muzyka, Iryna; See, Reiner B.; Cahill, Daniel P.; Carter, Bob S.; Curry, William T.; Jones, Pamela S.; Nahed, Brian V.; Peterfreund, Robert A.; Simon, Mirela V.
• Is Part Of: Clinical neurophysiology. Volume 130:Issue 6(2019:Jun.)
• Page Start: 1058
• Page End: 1065
• Publication Date: 2019-06
• Subjects: Stimulation triggered seizures -- Functional mapping -- Penfield method -- Multipulse train stimulation -- Antiepileptic drugs -- Gliomas; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2019.03.006
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Loading with AED before mapping decreases the risk of intraoperative seizures. Penfield stimulation and diffuse pathology independently increase this risk. Preoperative seizures have no impact, likely due to the protective effect of AED. Abstract: Objective: Intraoperative mapping via electrical stimulation is the gold standard technique for surgeries close to the eloquent cortex. However, it can trigger seizures which immediately impact patient's safety. We studied whether administration of antiepileptic drugs (AED) prior to and/or at the beginning of the surgery decreases the probability of triggering seizures, while adjusting for other risk factors. Methods: 544 consecutive intraoperative mapping cases performed at a tertiary care center for epilepsy and brain tumor surgery were included in the study. Using a multivariate logistic regression analysis, we analyzed the independent impacts of AED loading at time of surgery, preoperative AED maintenance, history of seizures, type of stimulation paradigm, lobar location of stimulation, age, opioid administration and pathology on the probability of triggering seizures. Results: Seizures were identified in 135 patients. Intravenous loading with AED decreased the odds of triggering seizures by 45% (OR = 0.55, p = 0.01), Penfield (versus multipulse train) stimulation and diffuse (versus well circumscribed) pathology increased it twice (OR = 1.97, p = 0.01) and 2.4 times (OR = 2.42, p = 0.003) respectively. No other factors had a significant impact. Conclusions: Seizures triggered during mapping occur frequently and are multifactorial. Significance: Loading with AED independently reduces the risk of their occurrence.