Specific afterdischarge properties can enhance the clinical utility of electrical stimulation mapping during intracranial monitoring

Zachary A. Kons, Vasileios Kokkinos, Amir Hadanny, William Muñoz, Nathaniel Sisterson, Mirela Simon, Alexandra Urban, R. Mark Richardson

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Extraoperative electrical cortical stimulation (ECS) facilitates defining the seizure onset zone (SOZ) and eloquent cortex. The clinical relevance of stimulation-induced afterdischarges (ADs) is not well defined. Methods: Fifty-five patients who underwent intracranial electroencephalogram evaluations with ECS were retrospectively identified. ADs were identified in these recordings and categorized by pattern, location, and association with stimulation-induced seizures. Results: ADs were generated in 1774/9285 (19%) trials. Rhythmic spikes and irregular ADs within the stimulated bipolar contact pair were predictive of location within the SOZ compared to non-epileptogenic/non-irritative cortex (rhythmic spikes OR 2.24, p = 0.0098; irregular OR 1.39; p = 0.013). ADs immediately preceding stimulated seizures occurred at lower stimulation intensity thresholds compared to other stimulations (mean 2.94 ± 0.28 mA vs. 4.16 ± 0.05 mA respectively; p = 0.0068). Conclusions: Changes in AD properties can provide clinically relevant data in extraoperative stimulation mapping. Significance: Although not exclusive to the SOZ, the generation of rhythmic spikes may suggest that a stimulation location is within the SOZ, while decreased stimulation intensity thresholds eliciting ADs may alert clinicians to a heightened probability of seizure generation with subsequent stimulation.

Original languageEnglish
Pages (from-to)13-23
Number of pages11
JournalClinical Neurophysiology
Volume159
StatePublished - Mar 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2024 International Federation of Clinical Neurophysiology

Keywords

  • Afterdischarges
  • Electrical cortical stimulation
  • Epilepsy surgery
  • Intracranial EEG

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