Download PDF
Journal of Pediatric Epilepsy 2022; 11(03): 075-079
DOI: 10.1055/s-0042-1743192
Original Article

Safety and Efficacy of Stereoelectroencephalography in Pediatric Epilepsy Surgery

Janani Kassiri 
1   Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
2   Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
,
Cameron Elliott
2   Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
3   Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
,
Natarie Liu
1   Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
2   Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
,
Karl Narvacan
4   Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
,
Matt Wheatly
2   Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
3   Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
,
D.Barry Sinclair
1   Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
2   Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Stereoelectroencephalography (SEEG) is the preoperative assessment of choice when the epileptogenic zone (EZ) is unclear in patients requiring surgery for severe, drug-refractory epilepsy. There are relatively little data on the safety and efficacy of SEEG in the pediatric epilepsy population. We, therefore, investigated the insertional complications, rate of successful identification of the EZ, and long-term seizure outcomes following surgery after SEEG in children. This was a retrospective study of drug-resistant pediatric epilepsy patients treated with surgery between 2005 and 2020 and who underwent presurgical SEEG. Rationale for and coverage of SEEG, identification of the EZ, and ultimate seizure outcome following SEEG-tailored resections were collected and analyzed. Thirty patients (15 male, mean age: 12.4 ± 5 years) who underwent SEEG were studied. SEEG-related complications occurred in one case (3%). A total of 190 multicontact electrodes (mean: 7.0 ± 2.5 per patient) were implanted across 30 insertions capturing 440 electrographic seizures (mean: 17.5 ± 27.6 per patient). The most common rationale for SEEG was normal magnetic resonance imaging with surface EEG that failed to identify the EZ (17/30; 57%). SEEG identified a putative EZ in all cases, resulting in SEEG-tailored resections in 25/30 (83%). Freedom from disabling seizures was achieved following resections in 20/25 cases (80%) with 5.9 ± 4.0 years of postoperative follow-up. SEEG is a safe and effective way to identify the EZ in the presurgical evaluation of children with refractory epilepsy and permits effective and long-lasting SEEG-tailored resections.

Keywords

pediatric epilepsy surgery - depth electrode - safety


Publication History

Received: 29 October 2021

Accepted: 30 December 2021

Article published online:
28 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Clusmann H, Kral T, Gleissner U. et al. Analysis of different types of resection for pediatric patients with temporal lobe epilepsy. Neurosurgery 2004; 54 (04) 847-859 , discussion 859–860
    CrossrefPubMedGoogle Scholar
  • 2 Englot DJ, Han SJ, Rolston JD. et al. Epilepsy surgery failure in children: a quantitative and qualitative analysis. J Neurosurg Pediatr 2014; 14 (04) 386-395
    CrossrefPubMedGoogle Scholar
  • 3 Gonzalez-Martinez J, Mullin J, Vadera S. et al. Stereotactic placement of depth electrodes in medically intractable epilepsy. J Neurosurg 2014; 120 (03) 639-644
    CrossrefPubMedGoogle Scholar
  • 4 Sinclair DB, Aronyk K, Snyder T. et al. Pediatric temporal lobectomy for epilepsy. Pediatr Neurosurg 2003; 38 (04) 195-205
    CrossrefPubMedGoogle Scholar
  • 5 Cossu M, Cardinale F, Colombo N. et al. Stereoelectroencephalography in the presurgical evaluation of children with drug-resistant focal epilepsy. J Neurosurg 2005; 103 (Suppl 4): 333-343
    PubMedGoogle Scholar
  • 6 Gonzalez-Martinez J, Bulacio J, Alexopoulos A, Jehi L, Bingaman W, Najm I. Stereoelectroencephalography in the “difficult to localize” refractory focal epilepsy: early experience from a North American epilepsy center. Epilepsia 2013; 54 (02) 323-330
    CrossrefPubMedGoogle Scholar
  • 7 Gonzalez-Martinez JA. The stereo-electroencephalography: the epileptogenic zone. J Clin Neurophysiol 2016; 33 (06) 522-529
    CrossrefPubMedGoogle Scholar
  • 8 Serletis D, Bulacio J, Bingaman W, Najm I, González-Martínez J. The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients. J Neurosurg 2014; 121 (05) 1239-1246
    CrossrefPubMedGoogle Scholar
  • 9 Sacino MF, Huang SS, Schreiber J, Gaillard WD, Oluigbo CO. Is the use of stereotactic electroencephalography safe and effective in children? A meta-analysis of the use of stereotactic electroencephalography in comparison to subdural grids for invasive epilepsy monitoring in pediatric subjects. Neurosurgery 2019; 84 (06) 1190-1200
    CrossrefPubMedGoogle Scholar
  • 10 UK Children's Epilepsy Surgery Collaboration. The UK experience of stereoelectroencephalography in children: an analysis of factors predicting the identification of a seizure-onset zone and subsequent seizure freedom. Epilepsia 2021; 62 (08) 1883-1896
    CrossrefPubMedGoogle Scholar
  • 11 Arya R, Mangano FT, Horn PS, Holland KD, Rose DF, Glauser TA. Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: a systematic review and meta-analysis. Epilepsia 2013; 54 (05) 828-839
    CrossrefPubMedGoogle Scholar
  • 12 Blauwblomme T, Ternier J, Romero C. et al. Adverse events occurring during invasive electroencephalogram recordings in children. Neurosurgery 2011; 69 (Suppl 2): 169-175
    PubMedGoogle Scholar
  • 13 Dorfmüller G, Ferrand-Sorbets S, Fohlen M. et al. Outcome of surgery in children with focal cortical dysplasia younger than 5 years explored by stereo-electroencephalography. Childs Nerv Syst 2014; 30 (11) 1875-1883
    CrossrefPubMedGoogle Scholar
  • 14 Johnston Jr JM, Mangano FT, Ojemann JG, Park TS, Trevathan E, Smyth MD. Complications of invasive subdural electrode monitoring at St. Louis Children's Hospital, 1994-2005. J Neurosurg 2006; 105 (5, Suppl): 343-347
    PubMedGoogle Scholar
  • 15 Onal C, Otsubo H, Araki T. et al. Complications of invasive subdural grid monitoring in children with epilepsy. J Neurosurg 2003; 98 (05) 1017-1026
    CrossrefPubMedGoogle Scholar
  • 16 Cossu M, Schiariti M, Francione S. et al. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy in infancy and early childhood. J Neurosurg Pediatr 2012; 9 (03) 290-300
    CrossrefPubMedGoogle Scholar
  • 17 Engel J. Surgical Treatment of the Epilepsies. 2nd edition.. New York: Raven Press; 1993
    Google Scholar
  • 18 Jacob FD, Wheatley MB, Sinclair DB. Acute neurogenic pulmonary edema after depth electrode placement for epilepsy surgery. Can J Neurol Sci 2010; 37 (06) 885-887
    CrossrefPubMedGoogle Scholar
  • 19 Mullin JP, Shriver M, Alomar S. et al. Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications. Epilepsia 2016; 57 (03) 386-401
    CrossrefPubMedGoogle Scholar
  • 20 Taussig D, Chipaux M, Lebas A. et al. Stereo-electroencephalography (SEEG) in 65 children: an effective and safe diagnostic method for pre-surgical diagnosis, independent of age. Epileptic Disord 2014; 16 (03) 280-295
    CrossrefPubMedGoogle Scholar
  • 21 Goldstein HE, Youngerman BE, Shao B. et al. Safety and efficacy of stereoelectroencephalography in pediatric focal epilepsy: a single-center experience. J Neurosurg Pediatr 2018; 22 (04) 444-452
    CrossrefPubMedGoogle Scholar
  • 22 McGovern RA, Knight EP, Gupta A. et al. Robot-assisted stereoelectroencephalography in children. J Neurosurg Pediatr 2018; 23 (03) 288-296
    CrossrefPubMedGoogle Scholar
  • 23 Dylgjeri S, Taussig D, Chipaux M. et al. Insular and insulo-opercular epilepsy in childhood: an SEEG study. Seizure 2014; 23 (04) 300-308
    CrossrefPubMedGoogle Scholar
  • 24 Vadera S, Mullin J, Bulacio J, Najm I, Bingaman W, Gonzalez-Martinez J. Stereoelectroencephalography following subdural grid placement for difficult to localize epilepsy. Neurosurgery 2013; 72 (05) 723-729 , discussion 729
    CrossrefPubMedGoogle Scholar
  • 25 Guenot M, Isnard J, Ryvlin P. et al. Neurophysiological monitoring for epilepsy surgery: the Talairach SEEG method. StereoElectroEncephaloGraphy. Indications, results, complications and therapeutic applications in a series of 100 consecutive cases. Stereotact Funct Neurosurg 2001; 77 (1-4): 29-32
    CrossrefPubMedGoogle Scholar
  • 26 Thorsteinsdottir J, Vollmar C, Tonn JC, Kreth FW, Noachtar S, Peraud A. Outcome after individualized stereoelectroencephalography (sEEG) implantation and navigated resection in patients with lesional and non-lesional focal epilepsy. J Neurol 2019; 266 (04) 910-920
    CrossrefPubMedGoogle Scholar
  • 27 Cardinale F, Rizzi M, Vignati E. et al. Stereoelectroencephalography: retrospective analysis of 742 procedures in a single centre. Brain 2019; 142 (09) 2688-2704
    CrossrefPubMedGoogle Scholar