Association of Cortical Stimulation–Induced Seizure With Surgical Outcome in Patients With Focal Drug-Resistant Epilepsy

Oderiz, Carolina Cuello; Ellenrieder, Nicolás von; Dubeau, François; Eisenberg, A.; Gotman, Jean; Hall, Jeffery A.; Hincapié, Ana-Sofía; Hoffmann, D.; Job, Anne‐Sophie; Khoo, Hui Ming; Minotti, Lorella; Olivier, André; Kahane, P.; Frauscher, Birgit

doi:10.1001/jamaneurol.2019.1464

Cited by 89 publications

(92 citation statements)

References 33 publications

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“…A final difference is that bedside stimulation mapping was performed in >70% of the SDE cases, but in the minority of SEEG cases, which may reflect in part an institutional bias and comfort with eloquent cortex mapping utilizing SDEs. However, we found stimulation‐induced seizures occurred over twice as frequently in the SEEG patients, similar to a recent study 42 . This observed difference may be explained by intrinsic biologic differences in excitability of the epileptic networks, electrode anatomic locations, variations in charge density applied between electrode types, rationale for mapping, or a combination of these and other factors 43 …”

Section: Discussionsupporting

confidence: 88%

Contemporaneous evaluation of patient experience, surgical strategy, and seizure outcomes in patients undergoing stereoelectroencephalography or subdural electrode monitoring

Kim

Parker

et al. 2020

Epilepsia

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ObjectiveIntracranial electrographic localization of the seizure onset zone (SOZ) can guide surgical approaches for medically refractory epilepsy patients, especially when the presurgical workup is discordant or functional cortical mapping is required. Minimally invasive stereotactic placement of depth electrodes, stereoelectroencephalography (SEEG), has garnered increasing use, but limited data exist to evaluate its postoperative outcomes in the context of the contemporaneous availability of both SEEG and subdural electrode (SDE) monitoring. We aimed to assess the patient experience, surgical intervention, and seizure outcomes associated with these two epileptic focus mapping techniques during a period of rapid adoption of neuromodulatory and ablative epilepsy treatments.MethodsWe retrospectively reviewed 66 consecutive adult intracranial electrode monitoring cases at our institution between 2014 and 2017. Monitoring was performed with either SEEG (n = 47) or SDEs (n = 19).ResultsBoth groups had high rates of SOZ identification (SEEG 91.5%, SDE 88.2%, P = .69). The majority of patients achieved Engel class I (SEEG 29.3%, SDE 35.3%) or II outcomes (SEEG 31.7%, SDE 29.4%) after epilepsy surgery, with no significant difference between groups (P = .79). SEEG patients reported lower median pain scores (P = .03) and required less narcotic pain medication (median = 94.5 vs 594.6 milligram morphine equivalents, P = .0003). Both groups had low rates of symptomatic hemorrhage (SEEG 0%, SDE 5.3%, P = .11). On multivariate logistic regression, undergoing resection or ablation (vs responsive neurostimulation/vagus nerve stimulation) was the only significant independent predictor of a favorable outcome (adjusted odds ratio = 25.4, 95% confidence interval = 3.48‐185.7, P = .001).SignificanceAlthough both SEEG and SDE monitoring result in favorable seizure control, SEEG has the advantage of superior pain control, decreased narcotic usage, and lack of routine need for intensive care unit stay. Despite a heterogenous collection of epileptic semiologies, seizure outcome was associated with the therapeutic surgical modality and not the intracranial monitoring technique. The potential for an improved postoperative experience makes SEEG a promising method for intracranial electrode monitoring.

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Section: Discussionsupporting

confidence: 88%

Contemporaneous evaluation of patient experience, surgical strategy, and seizure outcomes in patients undergoing stereoelectroencephalography or subdural electrode monitoring

Kim

Parker

et al. 2020

Epilepsia

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“…Whether clinical signs occurred earlier during DCS-S than during SS was not evaluated, a finding that seems frequent in DCS-S presenting with initial motor semiology. 41 In a second SEEG series where 59 (57%)/103 patients had at least one electroclinical DCS-S, 42 the groups of Montreal and Grenoble showed that the use of 50 Hz DCS and longer time (>24 hours) since the last seizure was associated with a higher likelihood of seizure elicitation ( P < .05). More importantly, they demonstrated that the percentage of patients with DCS-S was higher in the good (Engel class I) versus the poor (class II-III-IV) surgical outcome group (70% vs 47%, P = .020), and that the median percentage of the resected contacts encompassing the DCS-induced seizure-onset zone was higher in the good (63%) versus the poor (33%) surgical outcome group ( P = .003).…”

Section: Identifying the Seizure Onset Zone And The Size Of The Resecmentioning

confidence: 97%

Intracranial EEG in the 21st Century

et al. 2020

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Intracranial electroencephalography (iEEG) has been the mainstay of identifying the seizure onset zone (SOZ), a key diagnostic procedure in addition to neuroimaging when considering epilepsy surgery. In many patients, iEEG has been the basis for resective epilepsy surgery, to date still the most successful treatment for drug-resistant epilepsy. Intracranial EEG determines the location and resectability of the SOZ. Advances in recording and implantation of iEEG provide multiple options in the 21st century. This not only includes the choice between subdural electrodes (SDE) and stereoelectroencephalography (SEEG) but also includes the implantation and recordings from microelectrodes. Before iEEG implantation, especially in magnetic resonance imaging -negative epilepsy, a clear hypothesis for seizure generation and propagation should be based on noninvasive methods. Intracranial EEG implantation should be planned by a multidisciplinary team considering epileptic networks. Recordings from SDE and SEEG have both their advantages and disadvantages. Stereo-EEG seems to have a lower rate of complications that are clinically significant, but has limitations in spatial sampling of the cortical surface. Stereo-EEG can sample deeper areas of the brain including deep sulci and hard to reach areas such as the insula. To determine the epileptogenic zone, interictal and ictal information should be taken into consideration. Interictal spiking, low frequency slowing, as well as high frequency oscillations may inform about the epileptogenic zone. Ictally, high frequency onsets in the beta/gamma range are usually associated with the SOZ, but specialized recordings with combined macro and microelectrodes may in the future educate us about onset in higher frequency bands. Stimulation of intracranial electrodes triggering habitual seizures can assist in identifying the SOZ. Advanced computational methods such as determining the epileptogenicity index and similar measures may enhance standard clinical interpretation. Improved techniques to record and interpret iEEG may in the future lead to a greater proportion of patients being seizure free after epilepsy surgery.

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“…To date, few studies have directly correlated the use of SEEG ESM with surgical outcomes as measured using the Engel classification system. However, more studies have investigated the ability of stimulation to induce electro-clinical seizures matching the (37). Another study of patients with polymicrogyria (PMG) showed that, while only partial PMG-EZ concordance was found in 74% of cases, subsequent surgery resulted in a favorable outcome in 72% of patients (Engel class I at mean 4.6-year follow-up) (38).…”

Section: Primary Clinical Outcome Metrics Derived From Seeg Stimulatimentioning

confidence: 99%

Stimulation Mapping Using Stereoelectroencephalography: Current and Future Directions

et al. 2020

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Electrical stimulation mapping (ESM) using stereoelectroencephalography (SEEG) is an essential component in the workup of surgical epilepsy. Since the initial application of ESM in the mid-1960s, it remains unparalleled in defining eloquent brain areas and delimiting seizure foci for the purposes of surgical planning. Here, we briefly review the current state of SEEG stimulation, with a focus on the techniques used for identifying the epileptogenic zone and eloquent cortex. We also summarize clinical data on the efficacy of SEEG stimulation in surgical outcomes and functional mapping. Finally, we briefly highlight future applications of SEEG ESM, including novel functional mapping approaches, identifying rare seizure semiologies, neurophysiologic investigations for understanding cognitive function, and its role in SEEG-guided radiofrequency thermal coagulation.

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Association of Cortical Stimulation–Induced Seizure With Surgical Outcome in Patients With Focal Drug-Resistant Epilepsy

Cited by 89 publications

References 33 publications

Contemporaneous evaluation of patient experience, surgical strategy, and seizure outcomes in patients undergoing stereoelectroencephalography or subdural electrode monitoring

Contemporaneous evaluation of patient experience, surgical strategy, and seizure outcomes in patients undergoing stereoelectroencephalography or subdural electrode monitoring

Intracranial EEG in the 21st Century

Stimulation Mapping Using Stereoelectroencephalography: Current and Future Directions

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