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. 2020 Jun;141(6):463-472.
doi: 10.1111/ane.13229. Epub 2020 Mar 9.

Outcomes of stereoelectroencephalography exploration at an epilepsy surgery center

Joseph Samuel Peedicail  1 , Amal Almohawes  1 , Walter Hader  1 , Yves Starreveld  1 , Shaily Singh  1 , Colin Bruce Josephson  1 , William Murphy  1 , Paolo Federico  1 , Samuel Wiebe  1 , Neelan Pillay  1 ; Calgary Comprehensive Epilepsy Program collaborators
Collaborators, Affiliations

Outcomes of stereoelectroencephalography exploration at an epilepsy surgery center

Joseph Samuel Peedicail et al. Acta Neurol Scand. 2020 Jun.

Abstract

Objectives: Epilepsy surgery is offered in resistant focal epilepsy. Non-invasive investigations like scalp video EEG monitoring (SVEM) help delineate epileptogenic zone. Complex cases may require intracranial video EEG monitoring (IVEM). Stereoelectroencephalography (SEEG)-based intracerebral electrode implantation has better spatial resolution, lower morbidity, better tolerance, and superiority in sampling deep structures. Our objectives were to assess IVEM using SEEG with regard to reasoning behind implantation, course, surgical interventions, and outcomes.

Materials and methods: Seventy-two admissions for SEEG from January 2014 to December 2018 were included in the study. Demographic and clinical data were retrospectively collected.

Results: The cohort comprised of 69 adults of which 34 (47%) had lesional MRI. Reasons for SEEG considering all cases included non-localizing ictal onset (76%), ictal-interictal discordance (21%), discordant semiology (17%), proximity to eloquent cortex (33%), nuclear imaging discordance (34%), and discordance with neuropsychology (19%). Among lesional cases, additional reasons included SVEM discordance (68%) and dual or multiple pathology (47%). Forty-eight patients (67%) were offered resective surgery, and 41 underwent it. Twenty-three (56%) had at least one year post-surgical follow-up of which 14 (61%) had Engels class I outcome. Of the remaining 23 who were continued on medical management, 4 (17%) became seizure-free and 12 (51%) had reduction in seizure frequency.

Conclusion: SEEG monitoring is an important and safe tool for presurgical evaluation with good surgical and non-surgical outcomes. Whether seizure freedom following non-surgical management could be related to SEEG implantation, medication change, or natural course needs to be determined.

Keywords: drug-resistant focal epilepsy; epilepsy surgery; outcomes; stereoelectroencephalography.

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References

REFERENCES

    1. Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311-318.
    1. Engel J Jr, McDermott MP, Wiebe S, et al. Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA. 2012;307(9):922-930.
    1. Thadani VM, Williamson PD, Berger R, et al. Successful epilepsy surgery without intracranial EEG recording: criteria for patient selection. Epilepsia. 1995;36(1):7-15.
    1. Lee SK, Lee SY, Kim KK, Hong KS, Lee DS, Chung CK. Surgical outcome and prognostic factors of cryptogenic neocortical epilepsy. Ann Neurol. 2005;58(4):525-532.
    1. Zumsteg D, Wieser HG. Presurgical evaluation: current role of invasive EEG. Epilepsia. 2000;41(Suppl 3):S55-60.

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