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Case Reports
. 2024 Feb 28:9:106-111.
doi: 10.1016/j.cnp.2024.02.002. eCollection 2024.

Stereo-electroencephalographic seizure localization in patients with mesial temporal sclerosis: A single center experience

Bill Zhang  1 , Irina Podkorytova  2 , Ryan Hays  2 , Ghazala Perven  2 , Mark Agostini  2 , Jay Harvey  2 , Rodrigo Zepeda  2 , Sasha Alick-Lindstrom  2 , Marisara Dieppa  2 , Alex Doyle  2 , Rohit Das  2 , Bradley Lega  3 , Kan Ding  2
Affiliations
Case Reports

Stereo-electroencephalographic seizure localization in patients with mesial temporal sclerosis: A single center experience

Bill Zhang et al. Clin Neurophysiol Pract. .

Abstract

Objective: Epilepsy patients with mesial temporal sclerosis (MTS) on imaging who are drug-resistant usually undergo epilepsy surgery without previous invasive evaluation. However, up to one-third of patients are not seizure-free after surgery. Prior studies have identified risk factors for surgical failure, but it is unclear if they are associated with bilateral or discordant seizure onset.

Methods: In this retrospective case series, we identified 17 epilepsy patients who had MRI-confirmed MTS but received invasive stereo-EEG (SEEG) evaluation before definitive intervention. We analyzed their presurgical risk factors in relation to SEEG seizure onset localization and MRI/SEEG concordance.

Results: SEEG ictal onset was concordant with MTS localization (i.e. seizures started only from the hippocampus with MTS) in 5 out of 13 patients with unilateral MTS (UMTS) and in 3 out of 4 patients with bilateral MTS.No statistically significant association regarding concordance of SEEG ictal onset and MTS location was found in patients with such risk factors as a history of non-mesial temporal aura, frequent focal to bilateral tonic-clonic seizures, prior viral brain infection, or family history of epilepsy. Nine out of 13 UMTS patients had resective surgery only, 5 out of 9 (56 %) have Engel class I outcome at most recent follow-up (median 46.5 months, range 22-91 months). In Engel class I cohort, the SEEG ictal onset was concordant with MTS location in 3 out of 5 patients, and 2 patients had ipsilateral temporal neocortical ictal onset.

Conclusions: Our findings suggest that patients with MTS might have discordant SEEG ictal onset (in 61.5% patients with UMTS in presented cohort), which may explain poor surgical outcome after destructive surgery in these cases.

Significance: Although no statistically significant association was found in this under-powered study, these findings could be potentially valuable for future meta-analyses.

Keywords: Epilepsy risk factors; LITT; MTS; SEEG; Temporal lobectomy.

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