Safety and efficacy of stereoelectroencephalography in pediatric focal epilepsy: a single-center experience

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Patients with medically refractory localization-related epilepsy (LRE) may be candidates for surgical intervention if the seizure onset zone (SOZ) can be well localized. Stereoelectroencephalography (SEEG) offers an attractive alternative to subdural grid and strip electrode implantation for seizure lateralization and localization; yet there are few series reporting the safety and efficacy of SEEG in pediatric patients.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors review their initial 3-year consecutive experience with SEEG in pediatric patients with LRE. SEEG coverage, SOZ localization, complications, and preliminary seizure outcomes following subsequent surgical treatments are assessed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Twenty-five pediatric patients underwent 30 SEEG implantations, with a total of 342 electrodes placed. Ten had prior resections or ablations. Seven had no MRI abnormalities, and 8 had multiple lesions on MRI. Based on preimplantation hypotheses, 7 investigations were extratemporal (ET), 1 was only temporal-limbic (TL), and 22 were combined ET/TL investigations. Fourteen patients underwent bilateral investigations. On average, patients were monitored for 8 days postimplant (range 3–19 days). Nearly all patients were discharged home on the day following electrode explantation.</jats:p><jats:p>There were no major complications. Minor complications included 1 electrode deflection into the subdural space, resulting in a minor asymptomatic extraaxial hemorrhage; and 1 in-house and 1 delayed electrode superficial scalp infection, both treated with local wound care and oral antibiotics.</jats:p><jats:p>SEEG localized the hypothetical SOZ in 23 of 25 patients (92%). To date, 18 patients have undergone definitive surgical intervention. In 2 patients, SEEG localized the SOZ near eloquent cortex and subdural grids were used to further delineate the seizure focus relative to mapped motor function just prior to resection. At last follow-up (average 21 months), 8 of 15 patients with at least 6 months of follow-up (53%) were Engel class I, and an additional 6 patients (40%) were Engel class II or III. Only 1 patient was Engel class IV.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>SEEG is a safe and effective technique for invasive SOZ localization in medically refractory LRE in the pediatric population. SEEG permits bilateral and multilobar investigations while avoiding large craniotomies. It is conducive to deep, 3D, and perilesional investigations, particularly in cases of prior resections. Patients who are not found to have focally localizable seizures are spared craniotomies.</jats:p></jats:sec>

Stereoelectroencephalography Versus Subdural Electrodes for Localization of the Epileptogenic Zone: What Is the Evidence?

“…The perception that unfamiliar techniques (either SEEG or SDE) are less safe is 1 possible explanation for this debate and a possible reason why SEEG was not used outside of select centers for many years. This debate continues today despite numerous observational studies [7,27,[47][48][49][50][51] reporting on the safety of either SEEG or SDE. To date, there is a paucity of clinical studies providing direct comparisons of the safety of SEEG and SDE, possibly due to the fact that most centers use predominately SEEG or SDE, depending on their preferences.…”

“…First, a majority of the studies included were published by highly experienced SEEG groups in France and Italy and it is possible that the relatively low SEEG complication rates published reflect long-term experience with the technique and may not be replicable by centers that are less experienced with SEEG. However, this does not seem to be the case, as a retrospective series of SEEG published by groups that have traditionally used SDE reported complication rates [47,48] similar to those of experienced SEEG groups [7,24]. Second, these meta-analyses are based on observational data and, as such, may not be completely comparable to each other.…”

Stereoelectroencephalography in Pediatric Epilepsy Surgery

“…Abel et al [2] identified four children with asymptomatic ICH, one case of transient paresthesia associated with subdural hematoma, and another with headache associated with a minor electrode-tract ICH among 38 procedures. Goldstein et al [39] reviewed 30 SEEG explorations, finding one instance of electrode deflection resulting in asymptomatic extra-axial hemorrhage, and two cases of superficial scalp infection at the electrode entry site. These findings from pediatric series align with the more extensive literature involving adult or mixed cohorts [9,12,16,40,49,68,86], with a meta-analysis of SEEG outcomes from 2624 patients reporting a pooled prevalence of 1.0% for hemorrhagic complications and 0.8% for infectious complications [73].…”

Recent advances in the neurosurgical treatment of pediatric epilepsy

“…In a similar study, published in 2018, Goldstein et al report on their experience, with a focus on pediatric patients. 26 They report on 25 children who underwent 30 SEEG procedures involving implantation of a total of 342 electrodes. In their series, no major complications occurred, but they did observe 4 asymptomatic intracranial hemorrhages and 2 superficial scalp infections that were treated with oral antibiotics.…”