Study of surgical management and location of intractable epilepsy

Objective To evaluate the effect of a new localization mode and the effects of lesionectomy and/or multiple subpial transection(MST)under monitoring of intra-operative ECoG recordings for treatment of intractable epilepsy.Method The localization mode of CT+MRI +EEG+SPECT+ECoG was used in47patients for the sake of increasing the detection rate of the focus of intractable epilepsy.The positive focuses were resected and followed by MST if the localized spike activity still existed after the lesionectomy,both operations were performed under monitoring of intraoperative ECoG recordings.In some functional areas,only MST was performed.Result The epileptogenic focuses were discovered in86%of the patients.91percent of the patients treated with the surgery were seizure free,but 15%of them recurred after6monthes with reduction of seizure frequency and severity.Conclusion The localization mode of CT+MRI +EEG+SPECT+ECoG increased the detection rate of the epileptogenic focus nearly to that detected with PET and had a important localization value in surgery of intractable epilepsy.Lesionectomy and multiple subpial transection(MST)under monitoring of intra-operative ECoG recordings had minimal damage,reliable effect,high rate of seizure free,low rate of complications and recurrence.Incomplete lesionectomy,cortex necrosis,and scar formation might be the causes of recurrence.