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. 2023 Jul:193:107162.
doi: 10.1016/j.eplepsyres.2023.107162. Epub 2023 May 5.

Stereo-EEG localization of midline onset seizures on scalp EEG

Kelsey M Smith  1 , Donnie K Starnes  2 , Benjamin H Brinkmann  2 , Elson So  2 , Benjamin C Cox  2 , W Richard Marsh  3 , Jamie J Van Gompel  3 , Elaine Wirrell  2 , Jeffrey W Britton  2 , David B Burkholder  2 , Lily C Wong-Kisiel  2
Affiliations

Stereo-EEG localization of midline onset seizures on scalp EEG

Kelsey M Smith et al. Epilepsy Res. 2023 Jul.

Abstract

Purpose: The objective of this study was to describe the sEEG-defined seizure onset zone (SOZ), seizure semiology, presurgical evaluations, surgical intervention and outcome in patients with midline onset noninvasive phase I monitoring.

Methods: A single center sEEG database was reviewed to identify patients with seizures onset predominantly involving midline electrodes (FZ, CZ, PZ, OZ) on scalp EEG. Data abstracted included clinical factors, seizure semiology graded into lobar segmentation, imaging and electrographic findings, sEEG plan, interventions, and outcome.

Results: Twelve patients were identified (8 males, median age of sEEG 28 years) out of 100 cases of sEEG performed from January 2015-September 2019. "Frontal lobe" seizure semiology was the most common. sEEG-defined SOZ were frontal (5), diffuse (1), multifocal (1), frontal and insular (1), frontal and cingulate (1), insular (1), cingulate (1), and mesial temporal (1). CZ and/or FZ scalp EEG changes were present for all patients with SOZ involving the frontal, cingulate, and insular regions. PZ/OZ scalp involvement was present in one patient with mesial temporal SOZ. Four patients underwent a definitive resective or ablative surgery, and the remaining patients underwent a palliative intervention. Of those with follow-up information available, 8/11 had seizure reduction by ≥ 50%, including 4 with an Engel I outcome. No clinical factors were associated with outcome.

Conclusions: SOZ for midline onset seizures from noninvasive phase I monitoring was most commonly in the frontal, cingulate, and insular regions. A complex cortical network between these regions may explain overlap in semiology and scalp EEG findings. While the number rendered seizure-free was limited, a significant proportion experienced a reasonably favorable outcome justifying use of sEEG to identify surgical options in these patients.

Keywords: Cortical network; Epilepsy surgery; Midline onset seizures; Stereo-EEG.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: K. Smith receives research support through a grant from CURE Epilepsy. D. Starnes reports no disclosures. B. Brinkmann has received research support from UNEEG Medical A/S and Seer Medical Pty. Ltd, and has received device donations for research from Medtronic Inc. He has licensed IP to Cadence Neurosciences, and has consulted for Otsuka Pharmaceuticals. E. So reports no disclosures. B. Cox reports no disclosures. W. Marsh reports no disclosures. J. Van Gompel is a named inventor for intellectual property licensed to Cadence Neuroscience Inc, which is co-owned by Mayo Clinic, investigator for the Medtronic EPAS trial, SLATE trial, and Mayo Clinic Medtronic NIH Public Private Partnership (UH3-NS95495), also with consulting contract, Stock Ownership and Consulting Contract with Neuro-One Inc, site Primary Investigator in the Polyganics ENCASE II trial, site Primary Investigator in the NXDC Gleolan Men301 trial, and site Primary Investigator in the Insightec MRgUS EP001 trial. E. Wirrell has received consulting income from Acadia, Amicus, Neurocrine and Encoded Therapeutics. She also receives income from Epilepsy.com for serving as Co-Editor in Chief. J. Britton has an inventor agreement with SEER Medical. D. Burkholder is the site PI for Longboard Pharmaceuticals LP352 study. L. Wong-Kisiel reports no disclosures.

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