Complications of subdural and depth electrodes in 269 patients undergoing 317 procedures for invasive monitoring in epilepsy

Schmidt, Richard F.; Wu, Chengyuan; Lang, Michael J; Soni, Pranay; Williams, Kim A.; Boorman, David W.; Evans, James J.; Sperling, Michael R.; Sharan, Ashwini

doi:10.1111/epi.13503

Cited by 67 publications

(64 citation statements)

References 27 publications

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“…Therefore, seizure control at 2 months after SEEG‐guided RF‐TC is now routinely taken into account as a therapeutic test in our daily activity, before any surgical decision. SEEG tends to be the gold standard for phase II investigations because of its low complication rate and its high ability to explore deep region in comparison to subdural grid electrodes . Whereas the classical approach of the Franco‐Italian school is to perform resective surgery some weeks after SEEG, other teams perform surgery at the time of electrode ablation.…”

Section: Discussionmentioning

confidence: 99%

Stereo electroencephalography–guided radiofrequency thermocoagulation (SEEG‐guided RF‐TC) in drug‐resistant focal epilepsy: Results from a 10‐year experience

et al. 2016

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SUMMARYObjective: Stereo electroencephalography (SEEG)-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) has been proposed since 2004 as a possible treatment of some focal drug-resistant epilepsy. The aim of this study is to provide extensive data about efficacy and safety of SEEG-guided RF-TC. Methods: Over a 10-year period, 162 patients with drug-resistant focal epilepsy were eligible for SEEG-guided RF-TG during phase II invasive investigation by SEEG. All follow-up and safety data were collected prospectively. The primary outcome was seizure freedom at 2 months and at 1 year after SEEG-guided RF-TC. Secondary outcomes were the responders' rate (patient with at least 50% decrease in seizure frequency) and their long-term follow-up. Results: Twenty-five percent of patients were seizure-free at 2 months and 7% at 1 year. We reported 67% of responders at 2 months and 48% at 1 year; 58% of responders maintained their status during the long-term follow-up. The seizure outcome was significantly better when the SEEG-guided RF-TC involved the occipital region (p = 0.007). When surgery followed an SEEG-guided RF-TC, the positive predictive value of being a responder 2 months after an SEEG-guided RF-TC and to be Engel's class I or II after surgery was 93%. We reported 1.1% of permanent deficit and 2.4% of transient side effects. Significance: Our results, gathered in a large population over a 10-year period, confirm that SEEG-guided RF-TC is a safe technique, being efficient in many cases. More than two thirds of patients showed a short-term improvement, and almost half of them were responders at 1-year follow-up. The technique appears to be especially interesting for limited epileptic zone inaccessible to surgery and when epilepsy is related to a large unilateral network (network disruption by multiple RF-TC). Furthermore, SEEG-guided RF-TC effect is a predictor of outcome after conventional cortectomy in patients eligible for surgery.

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Section: Discussionmentioning

confidence: 99%

Stereo electroencephalography–guided radiofrequency thermocoagulation (SEEG‐guided RF‐TC) in drug‐resistant focal epilepsy: Results from a 10‐year experience

et al. 2016

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“…At present, the gold standard for the identification of the EZ is invasive EEG . However, placement of intracranial and in particular subdural electrodes has a considerable burden of perioperative complications and several limitations in children . For these reasons, validation of noninvasive imaging techniques applied to the pediatric population for the identification of the EZ is essential .…”

Section: Introductionmentioning

confidence: 99%

“…11 However, placement of intracranial and in particular subdural electrodes has a considerable burden of perioperative complications and several limitations in children. 12 For these reasons, validation of noninvasive imaging techniques applied to the pediatric population for the identification of the EZ is essential. 13 Subtraction ictal SPECT coregistered to MRI (SISCOM) is a high-resolution imaging tool that provides high sensitivity and specificity localization of the seizure focus 14 with a remarkable predictive value of good surgical outcome.…”

Section: Introductionmentioning

confidence: 99%

Subtraction Ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy

et al. 2019

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Objective To assess feasibility and efficacy of subtraction ictal SPECT coregistered to MRI (SISCOM) for epilepsy localization in children who are candidates for resective surgery. Methods We retrospectively reviewed all patients ≤16 years with drug‐resistant epilepsy screened for epilepsy surgery in the University Hospital of Leuven from January 2009 to January 2018. Fifty‐eight hospitalizations for ictal SPECT and 51 SISCOM analyses in 44 patients were included. Mean age was 9.1 years. Hospitalizations for SISCOM were analyzed in terms of multiple variables affecting feasibility and efficacy. The localization of SISCOM was compared with the localization of the presumed epileptogenic zone (PEZ) as determined by video‐EEG. Results SISCOM was feasible in terms of chronic medication management, rescue antiepileptic therapy during hospitalization, and operative timings. Radiotracer injection occurred within 30 seconds from seizure onset in 91.4% of the patients. ictal SPECT imaging was performed within two hours from injection in 100% of the patients (mean: 40 minutes). SISCOM was able to localize the PEZ in 51.0% (26/51) and to additionally lateralize the PEZ in 17.6% (9/51), achieving better localizations than ictal SPECT, FDG‐PET, and MRI (P < .01). SISCOM was useful to localize the PEZ in 25% of patients with poorly localizing video‐EEG and in 27.8% of MRI‐negative cases. The occurrence of habitual seizures during injection for ictal SPECT and the temporal localization of the PEZ both correlated with a better SISCOM localization (P < .05). 36.4% (16/44) patients were finally selected for resective surgery, with a 87.5% seizure‐free rate at 12 months. A localizing SISCOM was associated with seizure freedom in 66.7% and with a Engel I‐II in 75.0% of our patients. Significance SISCOM is a reliable tool to localize the epileptogenic zone in clinical practice and is both feasible and useful in children, adding precious presurgical information especially in patients with noninformative MRI or a poorly localizing video‐EEG.

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“…This is clearly problematic as the distribution of neuroimaging abnormalities is often discordant with the topography of FR abnormalities (Hussain et al, 2016; Wu et al, 2010a). More expansive ECoG would mitigate such bias, though the potential benefit of additional sampling must be weighed against the risks of invasive monitoring, especially extended extraoperative monitoring (Schmidt et al, 2016). …”

Section: Discussionmentioning

confidence: 99%

Intraoperative fast ripples independently predict postsurgical epilepsy outcome: Comparison with other electrocorticographic phenomena

et al. 2017

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In the surgical management of epilepsy, the resection of cortex exhibiting interictal fast ripples (250–500 Hz) on electrocorticography has been linked to postoperative seizure-freedom. Although fast ripples appear to accurately identify the epileptogenic zone—the minimum tissue that must be removed at surgery to achieve seizure-freedom—it has not been established that fast ripples are a superior biomarker in comparison with multimodal presurgical neuroimaging and other electrocorticography abnormalities. Hence, in the prediction of postoperative seizure-freedom, we compared the value of fast ripples with other intraoperative electocorticography abnormalities including focal slowing, paroxysmal fast activity, intermittent spike discharges, continuous epileptiform discharges, focal attenuation, and intraoperative seizures, as well as complete resection of the lesion defined by MRI and other neuroimaging. In a cohort of 60 children with lesional epilepsy and median postsurgical follow-up exceeding 4 years, who underwent resective epilepsy surgery with intraoperative electrocorticography, we evaluated the extent to which removal of each intraoperative electrocorticography abnormality impacts time to first postoperative seizure using the Kaplan-Meier method and Cox proportional hazards regression. Secondly, we contrasted the predictive value of resection of each competing electrocorticography abnormality using standard test metrics (sensitivity, specificity, positive predictive value, and negative predictive value). In contrast with all other intraoperative electrocorticography abnormalities, fast ripples demonstrated the most favorable combination of positive predictive value (100%) and negative predictive value (76%) in the prediction of postoperative seizures. Among all candidate electrocorticography features, time to first postoperative seizure was most strongly associated with incomplete resection of fast ripples (hazard ratio = 19.8, p <0.001). In multivariate survival analyses, postoperative seizures were independently predicted by incomplete resection of cortex generating fast ripples (hazard ratio = 25.4, 95%CI 6.71 – 96.0, p < 0.001) and focal slowing (hazard ratio = 5.79, 95%CI 1.76 – 19.0, p = 0.004), even after adjustment for the impact of an otherwise complete resection. All children with incomplete resection of interictal FR-generating cortex exhibited postoperative seizures within six months. Notably, this cohort included many patients with large resections and thus limited opportunity to exhibit unresected fast ripples. Future study in a cohort with small resection volume, or a clinical trial in which resection margins are guided by fast ripple distribution, would likely yield a more precise estimate of the risk posed by unresected fast ripples. With a high detection rate during brief intraoperative electrocorticography and favorable positive and negative predictive value, interictal fast ripple characterization during surgery is a feasible and useful adjunct to standard methods for epilepsy surgery...

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Complications of subdural and depth electrodes in 269 patients undergoing 317 procedures for invasive monitoring in epilepsy

Cited by 67 publications

References 27 publications

Stereo electroencephalography–guided radiofrequency thermocoagulation (SEEG‐guided RF‐TC) in drug‐resistant focal epilepsy: Results from a 10‐year experience

Stereo electroencephalography–guided radiofrequency thermocoagulation (SEEG‐guided RF‐TC) in drug‐resistant focal epilepsy: Results from a 10‐year experience

Subtraction Ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy

Intraoperative fast ripples independently predict postsurgical epilepsy outcome: Comparison with other electrocorticographic phenomena

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