Abstract Details

Title Incidence of Seizures during Intraoperative Motor Evoked Potential Monitoring in a Large Cohort of Different Surgical Procedures

Topic Clinical Neurophysiology

Presentation(s) S39 - (-)

Poster/Presentation
Number 002

Objective

Background The incidence of seizures during intra-operative electrical brain stimulation has been previously reported in craniotomies exclusively (1-4 % in short train and 5-20% in Penfield stimulation).

Design/Methods We retrospectively reviewed the charts of 3779 patients that had intra-operative monitoring of the motor system from 2004-2012. Surgeries related with cranial structures (44.1%) included craniotomies, endovascular procedures and carotid endarterectomies. Spinal surgeries (52.2%) included degenerative, vascular and tumoral pathologies. Other surgeries (3.1%) included thoraco-abdominal pathologies compromising neural structures and procedures of neck and peripheral nerves. Motor evoked potentials (MEP) were recorded with needle electrodes inserted into upper and lower extremity muscles and elicited by short train of transcranial electrical stimulation (TES) (n=3332), direct cortical stimulation (DCS) (n=4) or both modalities (n=443). Parameters of TES and DCS stimulation were a short train of five electrical stimuli (0.5 ms duration), 4 ms inter-stimulus interval and 2 Hz train repetition rate.

Results In the group of 3779 patients, 25 patients (0.7%) had seizures during surgery. From those, 12 had a previous history of seizure. Electrical stimulation of patients that had an intraoperative seizure was applied by TES in 11 patients (0.3 %) and by both modalities (TES plus DCS) in 14 patients (3.3 %).

Conclusions We present the largest cohort of patients who underwent brain stimulation for monitoring the motor system. The rate of seizures was 0.7% for the whole group, 1.3% for cranial surgeries and 0.2 % for spine surgeries. The risk of seizures increased when TES was combined with DCS.

Authors/Disclosures
PRESENTER	No disclosure on file
Kathleen Seidel	No disclosure on file
Maria Tellez	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Gareth R. John (Mount Sinai School of Medicine)	No disclosure on file
Anthony Traboulsee, MD (University of British Columbia)	Dr. Traboulsee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Traboulsee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Traboulsee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Traboulsee has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Traboulsee has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for EMD Serono. Dr. Traboulsee has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche. The institution of Dr. Traboulsee has received research support from Roche. The institution of Dr. Traboulsee has received research support from Genzyme. The institution of Dr. Traboulsee has received research support from Consortium of MS Centers. The institution of Dr. Traboulsee has received research support from MS Canada. Dr. Traboulsee has received personal compensation in the range of $500-$4,999 for serving as a Workshop Chair with Consortium of MS Centers.

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