Ictal stereo-electroencephalography onset patterns of mesial temporal lobe epilepsy and their clinical implications

Feng, Rui; Hameed, Nazia; Hu, Jie; Lang, Liwei; He, Jiping; Wu, Dalei; Fan, Zhen; Jiang, Shize; Guo, Qinglong; Liu, Fengtao; Mao, Yiting; Li, Ce; Sun, Bing; Chen, Liang; Pan, Li

doi:10.1016/j.clinph.2020.05.033

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…35 Less is known about its importance in mesial temporal resections specifically, though a study examining single vs. multiple SOPs in patients who underwent resection of mesial temporal structures found that multiple SOPs were not associated with a worse outcome. 37…”

Section: Discussionmentioning

confidence: 99%

Seizure onset patterns predict outcome after stereotactic electroencephalography-guided laser amygdalohippocampotomy

Michalak

Greenblatt

et al. 2022

Preprint

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Objective: Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (sEEG) may miss seizure onset elsewhere. We hypothesized that sEEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the two-year outcomes of patients who underwent single-probe SLAH after sEEG and evaluated whether sEEG SOPs predict postoperative seizure freedom. Methods: This retrospective five-center study included patients with or without mesial temporal sclerosis (MTS) who underwent sEEG followed by single probe SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. A SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was two-year Engel I classification or recurrent seizures before then, stratified by SOP category. Results: 58 patients were included with a mean follow-up duration of 39 ± 12 months after SLAH. Overall one-, two, and three-year Engel I seizure freedom probability was 54%, 36%, and 33% respectively. Patients with SOPs including low voltage fast activity or low frequency repetitive spiking had a 46% two-year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log rank test, p = 0.00015). Significance: Patients who underwent SLAH after sEEG had a low probability of seizure freedom at two years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.

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Section: Discussionmentioning

confidence: 99%

Seizure onset patterns predict outcome after stereotactic electroencephalography-guided laser amygdalohippocampotomy

Michalak

Greenblatt

et al. 2022

Preprint

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“…Five seizure onset patterns were determined for MTLE, and 2 were correlated with MRI findings. Multiple seizure onset patterns did not predispose to poor outcomes in this subgroup, but multifocal seizure onsets especially when outside the resected area in the temporal region had poor outcomes ( 13 ). In a separate analysis by Lee et al ( 47 ), neocortical patterns of epilepsy in the pediatric population were explored.…”

Section: Types Of Seizure Patterns In Seeg: the Old And The Newmentioning

confidence: 91%

“…Contradicting evidence exists on the advantages of presurgical stimulation. The estimation of the concordance between stimulation-induced and spontaneous seizures was 90% for temporal regions in a recent study ( 13 ). A separate group found that afterdischarges could not be used as a standardized tool to localize EZ ( 2 ).…”

Section: Presurgical Cortical Stimulationmentioning

confidence: 95%

“…While SDEEG is followed by a determined surgical decision, SEEG provides different information on the following: resection of the EZ and complexity of the eloquent cortex (EC), ablation of a single contact involving the EZ, withholding a resection if risks are elevated ( 5 ). In general, patients that do not undergo resection after SEEG implantation and recording is up to 40% ( 2 , 13 ). Finally, in patients with non-lesional MRIs that have multifocal seizure origin during Phase I studies, invasive monitoring should be generally avoided ( 4 ).…”

Section: Indicationsmentioning

confidence: 99%

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Stereo-Encephalographic Presurgical Evaluation of Temporal Lobe Epilepsy: An Evolving Science

et al. 2022

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Drug-resistant epilepsy is present in nearly 30% of patients. Resection of the epileptogenic zone has been found to be the most effective in achieving seizure freedom. The study of temporal lobe epilepsy for surgical treatment is extensive and complex. It involves a multidisciplinary team in decision-making with initial non-invasive studies (Phase I), providing 70% of the required information to elaborate a hypothesis and treatment plans. Select cases present more complexity involving bilateral clinical or electrographic manifestations, have contradicting information, or may involve deeper structures as a part of the epileptogenic zone. These cases are discussed by a multidisciplinary team of experts with a hypothesis for invasive methods of study. Subdural electrodes were once the mainstay of invasive presurgical evaluation and in later years most Comprehensive Epilepsy Centers have shifted to intracranial recordings. The intracranial recording follows original concepts since its development by Bancaud and Talairach, but great advances have been made in the field. Stereo-electroencephalography is a growing field of study, treatment, and establishment of seizure pattern complexities. In this comprehensive review, we explore the indications, usefulness, discoveries in interictal and ictal findings, pitfalls, and advances in the science of presurgical stereo-encephalography for temporal lobe epilepsy.

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“…36 Less is known about its importance in mesial temporal resections specifically, although a study examining single versus multiple SOPs in patients who underwent resection of mesial temporal structures found that multiple SOPs were not associated with a worse outcome. 38 ED 28 was seen in 17 patients. Our study was not powered to determine whether ED is a relevant predictor for mesial temporal SLAH.…”

Section: Clinical Significance Of Individual Sopsmentioning

confidence: 96%

Seizure onset patterns predict outcome after stereo‐electroencephalography‐guided laser amygdalohippocampotomy

Michalak

Greenblatt

et al. 2023

Epilepsia

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Objective Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (stereo‐EEG) may miss seizure onset elsewhere. We hypothesized that stereo‐EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the 2‐year outcomes of patients who underwent single‐fiber SLAH after stereo‐EEG and evaluated whether stereo‐EEG SOPs predict postoperative seizure freedom. Methods This retrospective five‐center study included patients with or without mesial temporal sclerosis (MTS) who underwent stereo‐EEG followed by single‐fiber SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. An SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was 2‐year Engel I classification or recurrent seizures before then, stratified by SOP category. Results Fifty‐eight patients were included, with a mean follow‐up duration of 39 ± 12 months after SLAH. Overall 1‐, 2‐, and 3‐year Engel I seizure freedom probability was 54%, 36%, and 33%, respectively. Patients with SOPs, including low‐voltage fast activity or low‐frequency repetitive spiking, had a 46% 2‐year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log‐rank test, p = .00015). Significance Patients who underwent SLAH after stereo‐EEG had a low probability of seizure freedom at 2 years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between hippocampal seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.

show abstract

Ictal stereo-electroencephalography onset patterns of mesial temporal lobe epilepsy and their clinical implications

Cited by 13 publications

References 20 publications

Seizure onset patterns predict outcome after stereotactic electroencephalography-guided laser amygdalohippocampotomy

Seizure onset patterns predict outcome after stereotactic electroencephalography-guided laser amygdalohippocampotomy

Stereo-Encephalographic Presurgical Evaluation of Temporal Lobe Epilepsy: An Evolving Science

Seizure onset patterns predict outcome after stereo‐electroencephalography‐guided laser amygdalohippocampotomy

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