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Complex Central Cortex in Pediatric Patients With Malformations of Cortical Development

Neurosurgery Department of Pediatrics and Surgery, The Hospital for Sick Children, Toronto

Hiroshi Otsubo, MD

Division of Neurology, The Hospital for Sick Children, Toronto, hiroshi.otsubo{at}sickkids.ca, Bloorview Epilepsy Research Program, and the University of Toronto Toronto, Ontario

Elizabeth W. Pang, PhD

Division of Neurology, The Hospital for Sick Children, Toronto

James T. Rutka, MD, PhD

Neurosurgery Department of Pediatrics and Surgery, The Hospital for Sick Children, Toronto

Shiro Chitoku, MD

Division of Neurology, The Hospital for Sick Children, Toronto, Bloorview Epilepsy Research Program, and the University of Toronto Toronto, Ontario

Shelly K. Weiss, MD

Division of Neurology, The Hospital for Sick Children, Toronto

O. Carter Snead, MD

Division of Neurology, The Hospital for Sick Children, Toronto, Bloorview Epilepsy Research Program, and the University of Toronto Toronto, Ontario

We investigated whether malformations of cortical development yield a complex central cortex by studying nine children with malformations of cortical development and seven without malformations who underwent epilepsy surgery following extraoperative subdural somatosensory evoked potential and electrical stimulation to identify the sensorimotor cortex. We analyzed superficial structures of the central cortex, latency, amplitude, and location of N20 and P25. Sensorimotor responses in malformations of cortical development extended across the central sulcus in 1 to 4 of 3 to 12 electrodes (mean 32%) compared with 1 to 6 of 4 to 15 electrodes (mean 12%) in cases without malformations with a statistical significance (P < .05). N20 amplitudes were lower in epileptic than nonepileptic cortices (three with and three without malformations of cortical development) (P < .05). The central vein coursed partially along the central sulcus in eight cases of malformations of cortical development and five cases without malformations. We conclude that the sensorimotor cortex in malformations of cortical development is more complex than in cases without malformations, reduced N20 amplitude is indicative of epileptic sensorimotor cortex, and superficial veins do not indicate the sensory and motor cortical boundary. (J Child Neurol 2002;17:347-352).

Journal of Child Neurology, Vol. 17, No. 5, 347-352 (2002)
DOI: 10.1177/088307380201700507


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