Electrocorticography in the management of surgically treated epileptic patients

To report our experience on 8 patients with mean age of onset of seizures of 8 years, who had intra-operative electrocorticography monitoring during the surgical treatment of their medically intractable partial epilepsy. Post-resection electrocorticography grades were according to Jay et al and seizure outcome was a according to Kobayashi et al grades. Five patients had temporal lobe surgery and 3 patients had extra temporal surgery. Four patients had post-resection electrocorticography grade A [no residual epileptic activity], two of them had seizure outcome grade 1 [free of seizures] and the other 2 had grade 11 [free of seizures on medication]. The other 4 patients had post-resection electrocorticography grade B [minimal residual epileptic activity] and all had seizure outcome grade 11 except one patient who had grade 111 [more than 50% reduction in seizure frequency]. Despite the small size of our study, our results suggest that intra-operative electrocorticography may be an important tool in the surgical management of medically intractable epilepsy

Contribution of carbamazepine-10-11-epoxide to neurotoxicity in epileptic children on polytherapy

Carbamazepine-10-11-epoxide [CBZ-E] is a major metabolite of car bamazepine [CBZ]. CBZ-E has received recent attention because of its possible adverse side effects. A CBZ-E plasma level above 9 uM/L has been reported to be more often associated with side effects than are lower levels. We retrospectively reviewed health records of 88 children aged 6-16 years [mean, 10.7 years] on CBZ therapy. CBZ-E and other antiepileptic drug plasma levels were measured at the time of their neurologic evaluation. Three groups of patients were identified; a monotherapy group [n=48], a polytherapy group without neurotoxicity [n=36], and a polytherapy group with neurotoxicity [n=4]. All neurotoxic patients were on polytherapy and had plasma levels of CBZ and other AEDs within the therapeutic range but their plasma CBZ-E values were high [mean=15.8 microM/L, range 11-23]. CBZ-E plasma levels of the polytherapy group [11.6 microM/L] were significantly higher than those of the monotherapy group [5.8 micro M/L; p<0.001]. Monitoring CBZ-E plasma levels may provide more information on adverse effects of CBZ in children on polytherapy, although CBZ-E alone doesn't account for neurotoxicity