Epileptic Syndrome and Cranioplasty: Implication of Reconstructions in the Electroencephalogram

• Published in: World neurosurgery Vol. 137; pp. e517 - e525
• Main Authors: Pelegrini de Almeida, Leandro, Casarin, Mateus Carvalho, Mosser, Humberto Luiz, Worm, Paulo Valdeci
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2020
• Subjects: Cranioplasty; Decompressive craniectomy; Electroencephalography; Epilepsy; MM; RR; Epilepsy; EEG; EDH; DM; Cranioplasty; Electroencephalography; MCA; ES; BR; CT; Decompressive craniectomy; GCS; TBI; SAH; DC
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2020.02.036

In the presence of a skull deformity after large decompressive craniectomy (DC), neurologic deterioration manifesting as epileptic syndrome (ES) may occur independently of the primary disease or spontaneous improvement may be unduly impaired, and these unfavorable outcomes have sometimes been reversed by cranioplasty. The objective of this study was to analyze the influence of cranioplasty on the presence of ES in patients who underwent DC.
A prospective study was performed from October 2016 to October 2017 involving patients who underwent DC and subsequent cranioplasty. Electroencephalographic (EEG) status before and after cranioplasty was analyzed in the presence of seizures and was compared with results after DC.
The sample included 52 patients. Male sex (78.8%) and traumatic brain injury (82.7%) were common indications for DC. ES after DC was verified in 26.9% of patients, and 50% of patients presented with abnormal EEG status. ES after cranioplasty was noted in 21.2% and 36.3% of patients followed by abnormal EEG status. All patients with precranioplasty epileptogenic paroxysms showed better EEG tracings after the procedure.
In routine clinical practice, altered amplitudes were observed in the region of bone defects. Although cranioplasty reduced pathologic EEG status (epileptogenic paroxysms), it was not able to produce new EEG tracings that could predict changes in seizure discharge or reduce ES.