Parisi, Cristiano;
Giampiccolo, Davide;
Tramontano, Vincenzo;
Meneghelli, Pietro;
Tommasi, Nicola;
Galuppo, Marco;
Basaldella, Federica;
(2025)
Risk factors for intraoperative seizures during asleep motor evoked potential monitoring in supratentorial surgery.
Clinical Neurophysiology
, 180
, Article 2111387. 10.1016/j.clinph.2025.2111387.
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Giampiccolo_AAM_CLINPH-D-25-00083_R2.pdf - Accepted Version Access restricted to UCL open access staff until 18 October 2026. Download (3MB) |
Abstract
Objective: Intraoperative-seizures(IOS) following direct electrical stimulation(DES) affects intraoperative neurophysiological monitoring(IONM) and may lead to stop surgical resection. We analyzed IOS risk factors during asleep brain surgery. / / Methods: We reviewed 232 consecutive patients who underwent surgery for supratentorial brain lesions with IONM, that consisted in motor evoked potentials monitoring and mapping, elicited by DES using the train-of-five technique. Preoperative history of seizures, paresis, use of anti-seizure medications(ASM), stimulated cortical regions, histology, and motor performance were evaluated. IOS was defined as clinical seizure or an after-discharge. / / Results: IOS occurred in 35 patients (15.1 %). IOS risk increased with higher stimulation intensities, younger age, cavernomas, and a history of seizures, especially in patients without ASM at the time of surgery. IOS did not significantly impact the extent of resection or clinical outcome, but prolonged hospital stays. / / Conclusion: Our findings suggest that lower stimulation intensities are advisable when operating on patients with specific risk factors for IOS. / / Significance: We observed a significant increase in IOS risk with stimulation above 20 mA, thresholds being lower in high-risk patients. Tailored stimulation can reduce the risk of IOS. This study presents a large series on IOS risk factors during asleep surgeries and provides a review of these factors
| Type: | Article |
|---|---|
| Title: | Risk factors for intraoperative seizures during asleep motor evoked potential monitoring in supratentorial surgery |
| DOI: | 10.1016/j.clinph.2025.2111387 |
| Publisher version: | https://doi.org/10.1016/j.clinph.2025.2111387 |
| Language: | English |
| Additional information: | This version is the author-accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Intraoperative seizures (IOS), IONM, Epilepsy, Brain tumors, anti-seizure medications (ASM), Asleep surgery, Direct electrical stimulation |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10218146 |
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