Invasive pre-surgical epilepsy diagnostic in children: The advantage of depth electrodes combined with subdural grids in the evaluation of focal cortical dysplastic lesions

Pieper, Tom; Kudernatsch, Manfred; Kessler-Uberti, S; Eitel, HC; Pascher, B; Blümcke, Ingmar; Winkler, PA; Staudt, Martin; Holthausen, Hans

doi:10.1055/s-0031-1273985

Cited by 1 publication

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“…51 CEEG is specifically indicated when needing evaluation of large areas of the hemispheric surface for accurate topographic mapping of EC along with select deep targets/lesions. 50,61,62 It is particularly well suited for patients with hemispheric polymicrogyria with preserved function or other large ill-defined dysplastic lesions or tubers adjacent to EC, which may have atypical representation and need detailed cortical mapping. Likewise, patients with hippocampal sclerosis and FCD (dual pathology) often benefit from combined electrode use as do those presenting with divergent data in the context of large or deep-seated lesions.…”

Section: Specific Indicationsmentioning

confidence: 99%

Diagnostic utility of invasiveEEGfor epilepsy surgery: Indications, modalities, and techniques

et al. 2016

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Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography (IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary across epilepsy surgical centers; each modality has its advantages and limitations. IEEG can be performed in the same intraoperative setting, that is, intraoperative electrocorticography, or through an independent implantation procedure with chronic extraoperative recordings; the latter are not only resource intensive but also carry risk. A lack of understanding of IEEG limitations predisposes to data misinterpretation that can lead to denying surgery when indicated or, worse yet, incorrect resection with adverse outcomes. Given the lack of class 1 or 2 evidence on IEEG, a consensus-based expert recommendation on the diagnostic utility of IEEG is presented, with emphasis on the application of various modalities in specific substrates or locations, taking into account their relative efficacy, safety, ease, and incremental cost-benefit. These recommendations aim to curtail outlying indications that risk the over- or underutilization of IEEG, while retaining substantial flexibility in keeping with most standard practices at epilepsy centers and addressing some of the needs of resource-poor regions around the world.

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Section: Specific Indicationsmentioning

confidence: 99%