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. 2023 Dec;8(4):1622-1627.
doi: 10.1002/epi4.12846. Epub 2023 Nov 1.

Implantation and reimplantation of intracranial EEG electrodes in patients considering epilepsy surgery

Céline Eelbode  1   2 , Laurent Spinelli  1   2 , Marco Corniola  2   3   4   5 , Shahan Momjian  2   3 , Margitta Seeck  1   2 , Karl Schaller  2   3 , Pierre Mégevand  1   2
Affiliations

Implantation and reimplantation of intracranial EEG electrodes in patients considering epilepsy surgery

Céline Eelbode et al. Epilepsia Open. 2023 Dec.

Abstract

In patients with drug-resistant epilepsy who are considering surgery, intracranial EEG (iEEG) helps delineate the putative epileptogenic zone. In a minority of patients, iEEG fails to identify seizure onsets. In such cases, it might be worthwhile to reimplant more iEEG electrodes. The consequences of such a strategy for the patient are unknown. We matched 12 patients in whom the initially implanted iEEG electrodes did not delineate the seizure onset zone precisely enough to offer resective surgery, and in whom additional iEEG electrodes were implanted during the same inpatient stay, to controls who did not undergo reimplantation. Seven cases and eight controls proceeded to resective surgery. No intracranial infection occurred. One control suffered an intracranial hemorrhage. Three cases and two controls suffered from a post-operative neurological or neuropsychological deficit. We found no difference in post-operative seizure control between cases and controls. Compared to an ILAE score of 5 (ie, stable seizure frequency in the absence of resective surgery), cases showed significant improvement. Reimplantation of iEEG electrodes can offer the possibility of resective epilepsy surgery to patients in whom the initial iEEG investigation was inconclusive, without compromising on the risk of complications or seizure control.

Keywords: complications; outcome; seizure onset zone.

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Conflict of interest statement

MS is in the advisory board of, and owns shares in, Epilog. The other authors have no conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Number of implanted electrodes (A) and individual contacts (B) for the case patients' first and second implantations, and for the controls' implantation. The lines relate each case's first and second implantations.
FIGURE 2
FIGURE 2
Postoperative seizure outcome. Case–control pairs are linked. Green symbols represent favorable outcome (ILAE score 1–3), red symbols unfavorable outcome (ILAE score 4–6). Gray symbols denote patients who did not undergo resective surgery, and whose seizures did not change significantly in terms of frequency and severity (corresponding to an ILAE score of 5).
See this image and copyright information in PMC

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