Clinical Usefulness of Intraoperative Motor-Evoked Potential Monitoring during Temporal Lobe Epilepsy Surgery
10.3988/jcn.2019.15.3.285
- Author:
Dae Lim KOO
1
;
Won Gu LEE
;
Seung Chyul HONG
;
Dae Won SEO
Author Information
1. Department of Neurology, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
temporal lobe epilepsy;
intraoperative monitoring;
motor-evoked potentials
- MeSH:
Electrodes;
Epilepsy, Temporal Lobe;
Evoked Potentials, Somatosensory;
Extremities;
Humans;
Intraoperative Neurophysiological Monitoring;
Monitoring, Intraoperative;
Muscles;
Nervous System;
Stroke;
Temporal Lobe
- From:Journal of Clinical Neurology
2019;15(3):285-291
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND PURPOSE: We aimed to determine the effectiveness of intraoperative neurophysiological monitoring focused on the transcranial motor-evoked potential (MEP) in patients with medically refractory temporal lobe epilepsy (TLE). METHODS: We compared postoperative neurological deficits in patients who underwent TLE surgery with or without transcranial MEPs combined with somatosensory evoked potential (SSEP) monitoring between January 1995 and June 2018. Transcranial motor stimulation was performed using subdermal electrodes, and MEP responses were recorded in the four extremity muscles. A decrease of more than 50% in the MEP or the SSEP amplitudes compared with baseline was used as a warning criterion. RESULTS: In the TLE surgery group without MEP monitoring, postoperative permanent motor deficits newly developed in 7 of 613 patients. In contrast, no permanent motor deficit occurred in 279 patients who received transcranial MEP and SSEP monitoring. Ten patients who exhibited decreases of more than 50% in the MEP amplitude recovered completely, although two cases showed transient motor deficits that recovered within 3 months postoperatively. CONCLUSIONS: Intraoperative transcranial MEP monitoring during TLE surgery allowed the prompt detection and appropriate correction of injuries to the motor nervous system or ischemic stroke. Intraoperative transcranial MEP monitoring is a reliable modality for minimizing motor deficits in TLE surgery.
