Study Of Cortex Thermocoagulation For Control Of Focal Epilepsy Arising From Functional Area

Objective:To investigate the safety and effectiveness of cortex thermocoagulation for control of epileptogenic foci located at functional area. Methods: 1 .The motor cortex in cats were thermocoagulated at different power, duration and interval. The specimens were taken one hour, three days, one week, one month and three months after thermocoagulation respectively. The histomophology and ultrastructure of the lesion and changes of motor function after thermocoagulation were reviewed. 2. Cat epilepsy model was established by injection of penicillin in the motor cortex. Seiure focus in the cortex were thermocoagulated to control of epilepsy, seizure outcome and electrocorticographic changes were observed 3. Cortex thermocoagulation were performed in patient's temporal lobes in different power and duration before performance of standard temporal lobectomy. Changes of histopathlogy and ultrastrcture had been studied in the lesion of cortex thermocoagulation after temporal lobes were resected. Results: 1. Behavior changes: No hemiplegia and unstable gait were observed in cats that were thermocoagulated at 4U/1S and 3U/2S. Hemoplegia and unstable gait took place in cats that were thermocoagulated at 4U/2S, 5U/1 S and5U/2S. 2. Macroscopic findings: There is a strip lesion in the area of cortex thermocoagulation in immediate specimens. The color of lesion altered with the changes of power and duration of thermocoagulation. No clear change was observed in the lesion in the specimens of one month and three months due to severe adhesion of the lesion and muscle. 3. Microscopic findings: The major histomophological change was an arc band between two forceps apex. The neurocytes in the arc band showed ischemic changes in immediate specimens, while gliosis in the specimens that were taken over seven days under microscope. The depth of lesion correlated well with the changes of power and duration of thermocoagulation. The bigger the power and the longer the duration,the deeper the lesion. 4. Ultrastructure: Swellingneurocytes, pyknotic neurocytes, lysis of cytoplasma and nucleolus were noted. Dendrites were swelling,in which mitochondrion and neurofilament disappeared. Pallor myeline, ruptured myeline and myelinoclasis were usually observed. 5. Seizure outcome: Acute focal epilepsy could be effectively controlled when the thermocoagulation power and duration is 4U/1 S. 6. After temporal lobes of human brain were thermocoagulated, the unmediate bistomophologic changes of the lesion were similar with cat抯. Concluaioa: Seizures could be effectively controlled through disrupting the horizontal fiber with cortex thermocoagulation at proper power and duration, and minimal neurological function was impaired. Therefore, we can offer a new surgical technique for the treatment of focal epilepsy arising from the functional cortex.