Comparison of bipolar versus monopolar extraoperative electrical cortical stimulation mapping in patients with focal epilepsy
Comparison of bipolar versus monopolar extraoperative electrical cortical stimulation mapping in patients with focal epilepsy
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DOI：
10.1016/j.clinph.2013.09.026
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发表时间：
2014-04-01
影响因子：
4.7
通讯作者：
Diehl, Beate
中科院分区：
文献类型：
--
作者：
Kovac, Stjepana;Scott, Catherine A.;Diehl, Beate
目的：术外皮层刺激（CS）在癫痫手术前对患者的大脑皮层进行定位，在各中心没有标准化。使用两种不同的技术，称为双极和单极CS。我们比较了双相和单极脑电图在硬膜下脑电图记录患者中识别有效皮层的能力和它们的安全性。方法：对5例患者行颅内脑电图记录及术外CS。双极与单极CS刺激参数、临床症状及放电后的系统比较。结果：与单极电刺激相比，双极电刺激所需的刺激电流更小，但耗时更长，更容易产生后放电。这些刺激都不会引起癫痫发作。双极或单极CS定义为有意义的区域仅显示轻微的不一致，主要涉及电极阵列的外排和边缘，仅产生单极CS的临床体征。定性地说，双和单极CS再现了相似的运动和肌肉收缩类型。结论：双极和单极CS是安全的方法，可以识别相似的皮层区域，尽管单极皮质刺激耗时更少。意义：研究结果提倡在临床环境中使用单极CS。(C) 2013年国际临床神经生理学联合会。爱思唯尔爱尔兰有限公司出版。版权所有。
Objective: Extraoperative cortical stimulation (CS) for mapping of eloquent cortex in patients prior to epilepsy surgery is not standardized across centres. Two different techniques are in use, referred to as bipolar and monopolar CS. We compared the ability of bipolar versus monopolar CS to identify eloquent cortex and their safety profile in patients undergoing subdural EEG recordings.Methods: Five patients undergoing intracranial EEG recordings and extraoperative CS. Systematic comparison of stimulus parameters, clinical signs and afterdischarges of bipolar versus monopolar CS.Results: Bipolar CS requires less stimulation current but is more time consuming and more likely to produce afterdischarges when compared to monopolar CS. None of the stimulations elicited seizures. The area defined as eloquent by either bipolar or monopolar CS reveals only minor discordances, involving mainly the outer row and edge of the electrode array producing clinical signs with monopolar CS only. Qualitatively, bi-and monopolar CS reproduced similar movements and types of muscle contractions.Conclusions: Bipolar and monopolar CS are safe procedures identifying similar cortical areas as eloquent, although monopolar cortical stimulation is less time consuming.Significance: Findings advocate the use of monopolar CS in a clinical setting. (C) 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.