The application research of Magnetoencephalograph, Wada test combined with neuronavigation in the surgical treatment of frontal and temporal epilepsy caused by focal cortical dysplasia_Journal of Epilepsy

Authors：

GUO Tao ¹ ,  GUO Fei ² , WU Jiang ¹ , YUE Xiangyong ¹

1. Department of Functional Neurosurgery, Hebei General Hospital, Shijiazhuang 050051, China;
2. Department of Rehabilitation, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;

Corresponding?author：

GUO Fei, Email: guofei620901@aliyun.com

Keywords：

Magnetoencephalograph; Wada test; Neuronavigation; Focal cortical dysplasia; Epilepsy; Surgical treatment

DOI：

10.7507/2096-0247.20180005

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Objective To investigate the application of Magnetoencephalograph (MEG), Wada test combined with neuronavigation in the surgical treatment of frontal and temporal epilepsy caused by focal cortical dysplasia (FCD ). Methods The epileptogenic focus and IQ, memory and language examination were performed in 34 patients with frontal and temporal epilepsy caused by FCD. MEG and Wada test were conducted to determine the language and memory advantage hemisphere, and to clarify the scope and memory function of language function areas. Operation was guided by the Medtronic stealhealth 7 surgical navigation system (USA) to remove the FCD and protect nerve function. IQ, memory and language examination were measured 1 year after operation, and the difference was observed before and after operation. The postoperative follow-up was 23 ~ 46 months, curative effect of epilepsy was determined according to the international anti-epilepsy union Engel’s standard. Results Thirty-four patients with epilepsy (21 temporal lobe epilepsy and 13 frontal lobe epilepsy) were included in this study. The examination process of MEG and Wada test was smooth. MEG can accurately locate the position of language function area. Twenty-eight patients’ dominant hemisphere of language was on the left and 6 was on the right side. Wada test can evaluate the patient’s memory function. Twenty-three patients’ dominant hemisphere of memory was located on the left, 8 on the right and 3 on the bilateral hemisphere. Compared with the dominant hemisphere and nondominant hemisphere, the memory score was significantly different (P<0.05). Statistics showed that the verbal IQ and total IQ increased (P<0.05)1 year after operation, but there was no significant change in memory IQ and Performance IQ (P>0.05). FCD patients recovered well without language, memory and limb impairment. The curative effect of epilepsy: 15 cases of Engel’sⅠgrade, 14 cases of Engel’sⅡgrade and 5 cases of Engel’s Ⅲ grade. Conclusion MEG, Wada test combined with neuronavigation was of important value in locating and guiding the surgical resection of FCD in patients with refractory frontal and temporal epilepsy, protecting cortical function, avoiding severe postoperative complications, and improving the therapeutic effect of epilepsy.

Citation： GUO Tao, GUO Fei, WU Jiang, YUE Xiangyong. The application research of Magnetoencephalograph, Wada test combined with neuronavigation in the surgical treatment of frontal and temporal epilepsy caused by focal cortical dysplasia. Journal of Epilepsy, 2018, 4(1): 18-23. doi: 10.7507/2096-0247.20180005 Copy

1.	李新宇, 張偉, 魯杰. 癲癇患者認知功能障礙及康復策略. 中華物理醫學與康復雜志, 2013, 35(3): 233-234.
2.	Perucca E. Optimizing antiepileptic drug treatment in tumoral epilepsy. Epilepsia, 2013, 54(Suppl 9): 97-104.
3.	Verrotti A, D’Egidio C, Agostinelli S, et al. Antiepileptic drug withdrawal in childhood epilepsy: what are the risk factors associated with seizure relapse?. Eur J Paediatr Neurol, 2012, 16(6): 599-604.
4.	郭韜, 劉倩薇, 陳堯, 等. 腦磁圖聯合彌散張量成像在常規磁共振成像陰性的額葉局灶性皮質發育不良術前評估中的應用價值. 中國全科醫學, 2015, 18(6): 729-732.
5.	Deling L, Nan J, Yongji T, et al. Intraventricular ganglioglioma prognosis and hydrocephalus: the largest case series and systematic literature review. Acta Neurochir (Wien), 2013, 155(7): 1253-1260.
6.	郭韜, 李文玲, 武江, 等. 腦磁圖描記聯合術中喚醒用于顯微鏡下切除功能區胚胎發育不良性神經上皮瘤. 第二軍醫大學學報, 2011, 32(2): 198-201.
7.	Passarelli V, Pinto LF, Jorge CL, et al. The intracarotid etomidate Wada test: A 54-patient series. Epilepsy Behav, 2014, 39: 73-77.
8.	Jehi LE, Palmini A, Aryal U, et al. Cerebral cavernous malformations in the setting of focal epilepsies: pathological findings, clinical characteristics, and surgical treatment principles. Acta Neuropathol, 2014, 128(1): 55-65.
9.	Kumar A, Chandra PS, Sharma BS, et al. The role of neuronavigation-guided functional MRI and diffusion tensor tractography along with cortical stimulation in patients with eloquent cortex lesions. Br J Neurosurg, 2014, 28(2): 226-233.
10.	Curot J, Denuelle M, Busigny T, et al. Bilateral Wada test: amobarbital or propofol?. Seizure, 2014, 23(2): 122-128.
11.	Bauer PR, Reitsma JB, Houweling BM, et al. Can fMRI safely replace the Wada test for preoperative assessment of language lateralisation? A meta-analysis and systematic review. J Neurol Neurosurg Psychiatry, 2014, 85(5): 581-588.
12.	Campos BM, Coan AC, Beltramini GC, et al. White matter abnormalities associate with type and localization of focal epileptogenic lesions. Epilepsia, 2015, 56(1): 125-132.
13.	郭韜, 劉倩薇, 陳堯, 等. 腦磁圖聯合彌散張量成像在常規磁共振成像陰性的額葉局灶性皮質發育不良術前評估中的應用價值. 中國全科醫學, 2015, 18(6): 729-732.
14.	Papanicolaou AC, Simos PG, Castillo EM, et al. Magnetocephalography: a noninvasive alternative to the Wada procedure. J Neurosurg, 2004, 100(5): 867-876.
15.	郭韜, 梁傳棟, 吳玉錦, 等. 腦磁圖聯合 DTI 對大腦半球萎縮繼發癲癇患者術前功能區評估的價值. 中華神經醫學雜志, 2014, 13(9): 919-924.

1. 李新宇, 張偉, 魯杰. 癲癇患者認知功能障礙及康復策略. 中華物理醫學與康復雜志, 2013, 35(3): 233-234.
2. Perucca E. Optimizing antiepileptic drug treatment in tumoral epilepsy. Epilepsia, 2013, 54(Suppl 9): 97-104.
3. Verrotti A, D’Egidio C, Agostinelli S, et al. Antiepileptic drug withdrawal in childhood epilepsy: what are the risk factors associated with seizure relapse?. Eur J Paediatr Neurol, 2012, 16(6): 599-604.
4. 郭韜, 劉倩薇, 陳堯, 等. 腦磁圖聯合彌散張量成像在常規磁共振成像陰性的額葉局灶性皮質發育不良術前評估中的應用價值. 中國全科醫學, 2015, 18(6): 729-732.
5. Deling L, Nan J, Yongji T, et al. Intraventricular ganglioglioma prognosis and hydrocephalus: the largest case series and systematic literature review. Acta Neurochir (Wien), 2013, 155(7): 1253-1260.
6. 郭韜, 李文玲, 武江, 等. 腦磁圖描記聯合術中喚醒用于顯微鏡下切除功能區胚胎發育不良性神經上皮瘤. 第二軍醫大學學報, 2011, 32(2): 198-201.
7. Passarelli V, Pinto LF, Jorge CL, et al. The intracarotid etomidate Wada test: A 54-patient series. Epilepsy Behav, 2014, 39: 73-77.
8. Jehi LE, Palmini A, Aryal U, et al. Cerebral cavernous malformations in the setting of focal epilepsies: pathological findings, clinical characteristics, and surgical treatment principles. Acta Neuropathol, 2014, 128(1): 55-65.
9. Kumar A, Chandra PS, Sharma BS, et al. The role of neuronavigation-guided functional MRI and diffusion tensor tractography along with cortical stimulation in patients with eloquent cortex lesions. Br J Neurosurg, 2014, 28(2): 226-233.
10. Curot J, Denuelle M, Busigny T, et al. Bilateral Wada test: amobarbital or propofol?. Seizure, 2014, 23(2): 122-128.
11. Bauer PR, Reitsma JB, Houweling BM, et al. Can fMRI safely replace the Wada test for preoperative assessment of language lateralisation? A meta-analysis and systematic review. J Neurol Neurosurg Psychiatry, 2014, 85(5): 581-588.
12. Campos BM, Coan AC, Beltramini GC, et al. White matter abnormalities associate with type and localization of focal epileptogenic lesions. Epilepsia, 2015, 56(1): 125-132.
13. 郭韜, 劉倩薇, 陳堯, 等. 腦磁圖聯合彌散張量成像在常規磁共振成像陰性的額葉局灶性皮質發育不良術前評估中的應用價值. 中國全科醫學, 2015, 18(6): 729-732.
14. Papanicolaou AC, Simos PG, Castillo EM, et al. Magnetocephalography: a noninvasive alternative to the Wada procedure. J Neurosurg, 2004, 100(5): 867-876.
15. 郭韜, 梁傳棟, 吳玉錦, 等. 腦磁圖聯合 DTI 對大腦半球萎縮繼發癲癇患者術前功能區評估的價值. 中華神經醫學雜志, 2014, 13(9): 919-924.

Journal of Epilepsy

The application research of Magnetoencephalograph, Wada test combined with neuronavigation in the surgical treatment of frontal and temporal epilepsy caused by focal cortical dysplasia

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