Jahodová Alena, Beňová Barbora, Kudr Martin, Ježdík Petr, Janča Radek, Bělohlávková Anežka, Liby Petr, Leško Róbert, Tichý Michal, Čelakovský Pavel, Kršek Pavel
Departments of1Paediatric Neurology and.
Departments of2Measurement and.
J Neurosurg Pediatr. 2020 Apr 17;26(2):150-156. doi: 10.3171/2020.2.PEDS19451. Print 2020 Aug 1.
Resective epilepsy surgery is an established treatment method for children with focal intractable epilepsy, but the use of this method introduces the risk of postsurgical motor deficits. Electrical stimulation mapping (ESM), used to define motor areas and pathways, frequently fails in children. The authors developed and tested a novel ESM protocol in children of all age categories.
The ESM protocol utilizes high-frequency electric cortical stimulation combined with continuous intraoperative motor-evoked potential (MEP) monitoring. The relationships between stimulation current intensity and selected presurgical and surgery-associated variables were analyzed in 66 children (aged 7 months to 18 years) undergoing 70 resective epilepsy surgeries in proximity to the motor cortex or corticospinal tracts.
ESM elicited MEP responses in all children. Stimulation current intensity was associated with patient age at surgery and date of surgery (F value = 6.81, p < 0.001). Increase in stimulation current intensity predicted postsurgical motor deficits (F value = 44.5, p < 0.001) without effects on patient postsurgical seizure freedom (p > 0.05).
The proposed ESM paradigm developed in our center represents a reliable method for preventing and predicting postsurgical motor deficits in all age groups of children. This novel ESM protocol may increase the safety and possibly also the completeness of epilepsy surgery. It could be adopted in pediatric epilepsy surgery centers.
切除性癫痫手术是治疗儿童局灶性难治性癫痫的一种既定方法，但该方法会带来术后运动功能缺损的风险。用于确定运动区域和通路的电刺激图谱（ESM）在儿童中经常失败。作者开发并测试了一种适用于所有年龄段儿童的新型ESM方案。
ESM方案利用高频皮层电刺激结合术中连续运动诱发电位（MEP）监测。分析了66例（年龄7个月至18岁）在运动皮层或皮质脊髓束附近接受70例切除性癫痫手术的儿童的刺激电流强度与术前及手术相关变量之间的关系。
ESM在所有儿童中均诱发了MEP反应。刺激电流强度与手术时患者年龄及手术日期相关（F值=6.81，p<0.001）。刺激电流强度增加预示着术后运动功能缺损（F值=44.5，p<0.001），但对患者术后癫痫发作缓解无影响（p>0.05）。
我们中心开发的拟议ESM模式是预防和预测所有年龄段儿童术后运动功能缺损的可靠方法。这种新型ESM方案可能会提高癫痫手术的安全性，也可能提高手术的彻底性。它可在儿科癫痫手术中心采用。
