Colocación de Electrodo de Profundidad, Tira y Rejilla para la monitorización de convulsiones parciales a través de electroencefalograma

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1 Colocación de Electrodo de Profundidad, Tira y Rejilla para la monitorización de convulsiones parciales a través de electroencefalograma Tipos de convulsiones Las convulsiones se pueden dividir en dos amplios grupos de convulsiones parciales y convulsiones generalizadas. Las convulsiones parciales (focales) se producen en una pequeña área del cerebro. Las convulsiones generalizadas se producen en muchos lugares del cerebro. En la mayoría de los pacientes con convulsiones, el tratamiento con medicamentos es la primera opción. La cirugía es una opción para algunos pacientes, mayormente aquellos con convulsiones parciales. Los electrodos son colocados en la superficie del cerebro para medir la actividad de convulsiones. La parte del cerebro que se determina causante de las convulsiones se denomina foco de la convulsión. Si sólo se descubre un lugar, se removerá esa parte del cerebro. Si la prueba muestra que existe más de un foco de convulsiones, es posible que la cirugía no sea beneficiosa para el paciente. Quién se puede beneficiar de la Colocación del Electrodo Se considera la realización de esta prueba para medir la actividad de las convulsiones en adultos y niños si tienen: Convulsiones Parciales convulsiones que comienzan en un área bastante pequeña. Convulsiones que no pueden controlarse con ninguno de los tres medicamentos para las convulsiones. Convulsiones que reducen la calidad la vida. Convulsiones que comienzan a una edad temprana. Convulsiones que comienzan en un área y se extienden de forma que causan una convulsión generalizada.

2 Qué son los electrodos? Los electrodos colocados debajo del cráneo (subdurales) son conectados a un monitor. Se utilizan para registrar la actividad de convulsiones en el cerebro. Esto nos indica de qué tipo de convulsión se trata y qué área del cerebro está causando el problema. Una vez que se encuentre esa área del cerebro, su doctor y el neurocirujano podrán decidir si esa área puede ser extraída de forma segura. Se utilizan tres tipos comunes de electrodos. Hay electrodos de profundidad, electrodos de tira, y rejilla. Los Electrodos de Profundidad están formados de alambres finos. Pueden registrar convulsiones que comienzan en áreas profundas del cerebro. Electrodos de Tira y Rejilla son aquellos colocados en una lámina fina de plástico. Estas tiras y rejillas son colocadas en la superficie del cerebro. Registran signos de convulsiones. Cómo se colocan los electrodos? Los electrodos de profundidad, tira y rejilla se colocan dentro o encima del cerebro durante la cirugía. Se realizará una incisión en el cuero cabelludo cerca del área donde se colocarán los electrodos. Se realizará un pequeño orificio circular en el cráneo para colocar los electrodos de profundidad y de tira. Se removerá un trozo de cráneo para colocar el electrodo de rejilla. El trozo de cráneo será colocado nuevamente en su sitio cuando el electrodo de rejilla sea removido. Pueden colocarle uno o más electrodos para monitorear si existe actividad convulsiva. Será necesario rasurarle la cabeza para realizar esta prueba. Mientras los electrodos estén colocados, tendrá que llevar un vendaje de gasa en la cabeza para mantener los electrodos firmemente en su lugar. Permanecerá en el hospital durante muchos días para monitorear las convulsiones mientras tenga los electrodos colocados. Antes de la cirugía Para preparase, necesitará ser sometido a un historial médico y un examen físico. Esto incluirá una revisión de su salud, un examen físico, y pruebas de sangre. Le pediremos que se lave el cabello con un jabón antibacterial la noche antes de la cirugía y la mañana de la cirugía. Frecuentemente usamos Hibiclens.

3 Después de la cirugía Después de la colocación, usted irá a la Unidad de Cuidados Intensivos (ICU por sus siglas en inglés) para mantenerle bajo observación y hacer un registro de las convulsiones. Es posible que le administren menos medicamento o que éste sea suspendido para producirle convulsiones. Si esto muestra convulsiones que se producen en muchas áreas o en ambos lados del cerebro, es posible que no se realice cirugía. Si esto muestra que las convulsiones comienzan en un área pequeña del cerebro, es posible que el cirujano pueda extraer esa parte del cerebro. Extracción de los electrodos Una vez que hayamos grabado suficiente información sobre las convulsiones, los electrodos serán removidos. Con frecuencia los electrodos de tira y profundidad se remueven mientras el paciente está acostado en la cama. Los electrodos de rejilla necesitan ser removidos en el quirófano. A quién debe llamar si tiene preguntas Por favor, cuando tenga una pregunta o preocupación llame a su neurocirujano o a la profesional en enfermería. Puede llamar a: Departamento de Neurocirugía, (608) English Version of this HFFY is # 5334 Copyright 2/2013 La Autoridad del Hospital y las Clínicas de la Universidad de Wisconsin, Madison. Todos los derechos reservados. Producido por el Departamento de Enfermería. Traducido del inglés por Beatriz Fernández-Jordá. HF# 6965

4 Depth, Strip and Grid Electrode Placement for EEG Monitoring in Partial Seizures Types of Seizures Seizures can be placed in two broad groups of partial seizures and generalized seizures. Partial seizures begin in a small area in the brain. Generalized seizures happen in many places of the brain. For most patients with seizures, treatment with drugs is the first choice for care. Surgery is an option for some patients, most often those with partial seizures. Electrodes are placed on the surface of the brain to measure seizure activity. The part of the brain found to be causing the seizures is labeled the seizure focus. If only one place is found, that part of the brain is removed. If the test shows more than one seizure focus, surgery may not be helpful. Who Would be Helped by Electrode Placement Adults and children with seizures are considered for this test to measure seizure activity if they have: Partial Seizures--seizures with a fairly small area where seizure begins Seizures that are not controlled by any of three anti-seizure drugs Seizures which lessen the quality of life Seizures that begin at an early age Seizures that start in one area and spread to cause a generalized seizure

5 What are Electrodes? Electrodes placed under the skull are attached to a monitor. They are used to pick up seizure action in the brain. This tells us the kind of seizure and the part of the brain causing the problem. After finding that part of the brain, your doctor and the brain surgeon can decide if it can be safely removed. There are three common types of electrodes used. They are depth electrodes, strip electrodes and grid. Depth Electrodes are made of thin wires. These can record seizures which start deep in the brain. Strip and Grid Electrodes are those planted in a thin sheet of plastic. These strips and grids are placed on the surface of the brain. They pick up signs of seizures. How are the Electrodes Placed? Depth, strip and grid electrodes are all placed in or on the brain during surgery. A cut is made in the scalp near the area where the electrode will be placed. A small burr hole is made in the skull to place the depth and strip electrodes. A piece of skull is removed to place the grid electrode. The piece of skull is replaced when the grid electrode is removed. You may have one or many electrodes placed to watch for seizure action. Your hair will be shaved for this test. While the electrodes are in place, you will need to wear a gauze bandage on your head to keep them firmly in place. You will stay in the hospital for many days to monitor the seizures while the electrodes are in place.

6 Before Surgery To prepare for this, you will need a health history and physical exam. This includes a review of your health, an exam of your body, and blood tests. The night before and the morning of surgery you will be asked to wash your hair with an antibacterial soap. We often use Hibiclens. After Surgery After placement, you will go to the Intensive Care Unit (ICU) to watch and keep a record of the seizures. You may be given less medicine or it may be stopped in order to cause seizures. If this shows seizures that start in many places or on both sides of the brain, surgery may not be done. If this shows that seizures are starting in a small area of the brain, the surgeon may be able to take out that part of the brain. Removal of the Electrodes After we record enough information about the seizures, the electrodes will be removed. Strip and depth electrodes are often removed at the bedside. Grids need to be removed in surgery. Who to Call with Questions Whenever you have a question or concern, please call your neurosurgeon or nurse practitioner. You can call: Department of Neurosurgery, at (608)

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