Análisis del fenómeno de electro-estimulación intracraneal mediante simulaciones y estimación de patrones de conectividad
Cargando...
Fecha
2023-11-21
Título de la revista
ISSN de la revista
Título del volumen
Editor
Resumen
La evaluación prequirúrgica de la epilepsia basada en estereoelectroencefalografía (SEEG) tiene un doble objetivo: definir la zona epileptogénica (EZ) y mapear la funcionalidad de la corteza en relación con el plan quirúrgico. La estimulación eléctrica cortical (EEC) representa una herramienta indispensable para definir la EZ. El objetivo de este trabajo fue estudiar los aspectos clínicos y electrofisiológicos de la EEC analizando el fenómeno eléctrico a través de simulaciones y patrones de conectividad, y evaluar su aporte en la selección del candidato a cirugía de la epilepsia. Se realizó un estudio transversal en la unidad de Video-EEG del Servicio de Neurociencias del Hospital El Cruce “Dr. Hospital Néstor Kirchner”, desde enero de 2016 a diciembre de 2019, en pacientes adultos con epilepsia fármaco-resistente, en quienes se realizó SEEG.
Se analizaron 36 pacientes. La EEC desencadenó crisis provocadas en 14 pacientes (39%), definidas como similares a las habituales, registradas previamente en un video-EEG de superficie y referidas por el paciente y/o familiares. En 14 pacientes (39%) la EEC desencadeno únicamente síntomas funcionales en relación al área cortical estimulada, referidos por el paciente y por el observador como diferentes a sus crisis habituales, y no fueron registradas previamente. En los 8 pacientes restantes (22.2%) la EEC no generó cambios. Se demostró con dos ejemplos clínicos reales que la planificación de la EEC por simulaciones es una herramienta de vital importancia para comprender y optimizar el mapeo cerebral y particularmente el mapeo de la ZE.
The presurgical evaluation of epilepsy based on stereoelectroencephalography (SEEG) has a double objective: to define the epileptogenic zone (EZ) and to map the functionality of the cortex in relation to the surgical plan. Cortical electrical stimulation (CEE) represents an indispensable tool for defining EZ. The objective of this work was to study the clinical and electrophysiological aspects of CEE by analyzing the electrical phenomenon through simulations and connectivity patterns, and to evaluate its contribution in the selection of the candidate for epilepsy surgery. A cross-sectional study was carried out in the Video-EEG unit of the Neuroscience Service of Hospital El Cruce “Dr. Hospital Néstor Kirchner ”, from January 2016 to December 2019, in adult patients with drug-resistant epilepsy, in whom SEEG was performed. Thirty six patients were analyzed. The CEE triggered provoked seizures, defined as similar to the usual ones, previously recorded in a surface video-EEG and referred by the patient and / or relatives, in 14 p (39%). In 14 patients (39%), CEE only triggered functional symptoms in relation to the stimulated cortical area, referred by the patient and by the observer as different from their usual seizures, and they were not previously registered. In the remaining 8 patients (22.2%), EEC did not generate changes. It was demonstrated with two real clinical examples that the planning of the CEE by simulations is a vitally important tool to understand and optimize the brain mapping and particularly the mapping of the EZ.
The presurgical evaluation of epilepsy based on stereoelectroencephalography (SEEG) has a double objective: to define the epileptogenic zone (EZ) and to map the functionality of the cortex in relation to the surgical plan. Cortical electrical stimulation (CEE) represents an indispensable tool for defining EZ. The objective of this work was to study the clinical and electrophysiological aspects of CEE by analyzing the electrical phenomenon through simulations and connectivity patterns, and to evaluate its contribution in the selection of the candidate for epilepsy surgery. A cross-sectional study was carried out in the Video-EEG unit of the Neuroscience Service of Hospital El Cruce “Dr. Hospital Néstor Kirchner ”, from January 2016 to December 2019, in adult patients with drug-resistant epilepsy, in whom SEEG was performed. Thirty six patients were analyzed. The CEE triggered provoked seizures, defined as similar to the usual ones, previously recorded in a surface video-EEG and referred by the patient and / or relatives, in 14 p (39%). In 14 patients (39%), CEE only triggered functional symptoms in relation to the stimulated cortical area, referred by the patient and by the observer as different from their usual seizures, and they were not previously registered. In the remaining 8 patients (22.2%), EEC did not generate changes. It was demonstrated with two real clinical examples that the planning of the CEE by simulations is a vitally important tool to understand and optimize the brain mapping and particularly the mapping of the EZ.
Descripción
Palabras clave
Estimulación eléctrica cortical, Epilepsia resistente a la medicación, Cirugía de la epilepsia, Electrical brain stimulation, Drug resistant epilepsy, Epilepsy surgery
Citación
Oddo, S. A., Collavini, S., Fernández Corazza, M. (2023). Análisis del fenómeno de electro-estimulación intracraneal mediante simulaciones y estimación de patrones de conectividad. Contribuciones de Ciencia y Tecnología, 1(1)