Stereo‐electroencephalography (SEEG) in 65 children: an effective and safe diagnostic method for pre‐surgical diagnosis, independent of age

Taussig, Delphine; Chipaux, Mathilde; Lebas, Axel; Fohlen, Martine; Bulteau, Christine; Ternier, Jessica; Ferrand-Sorbets, Sarah; Delalande, Olivier; Dorfmüller, Georg

doi:10.1684/epd.2014.0679

Cited by 74 publications

(79 citation statements)

References 24 publications

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“…There were 12 studies that reported on epilepsy duration, with no significant difference between SEEG patients (mean = 126.8 months ± 65.0, median = 121.8) and SDE patients (mean = 62.4 months ± 51.1, median = 51.4; Table ). Among the SEEG patients, the etiology was identified as a temporal epileptogenic focus in 42.2% of patients, tumor in 6.7% of patients, FCD1 in 39.2% of patients, FCD2 in 10.7% of patients, and lesional in 41.5% of patients .…”

Section: Resultsmentioning

confidence: 99%

“…Among 490 SEEG-informed patients who underwent resective surgery from nine studies, 310 patients (61.0%, 95% CI = 60.5-61.4%) were seizure-free. 15,16,22,23,27,28,32,33,49 Of the 953 SDE-informed patients who underwent resective surgery from 21 studies, 564 patients (56.4%, 95% CI = 55.7-57.1%) were seizurefree. 18,20,21,24,25,[35][36][37][38][39][40][41][42][43][44][45]47,48,[50][51][52] Therefore, SEEG-informed surgical resections have associations that suggest better seizure freedom outcomes than SDE-informed surgical resections (WMD = +5.8%, 95% CI = 4.7-6.9%, P = .001).…”

Section: Epileptic Surgery and Outcomesmentioning

confidence: 99%

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Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

et al. 2019

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Objective Invasive monitoring is sometimes necessary to guide resective surgery in epilepsy patients, but the ideal method is unknown. In this systematic review, we assess the association of postresection seizure freedom and adverse events in stereoelectroencephalography (SEEG) and subdural electrodes (SDE). Methods We searched three electronic databases (MEDLINE, Embase, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to January 2018 with the keywords “electroencephalography,” “intracranial grid,” and “epilepsy.” Studies that presented primary quantitative patient data for postresection seizure freedom with at least 1 year of follow‐up or complication rates of SEEG‐ or SDE‐monitored patients were included. Two trained investigators independently collected data from eligible studies. Weighted mean differences (WMDs) with 95% confidence interval (CIs) were used as a measure of the association of SEEG or SDE with seizure freedom and with adverse event outcomes. Results Of 11 462 screened records, 48 studies met inclusion criteria. These studies reported on 1973 SEEG patients and 2036 SDE patients. Our systematic review revealed SEEG was associated with 61.0% and SDE was associated with 56.4% seizure freedom after resection (WMD = +5.8%, 95% CI = 4.7‐6.9%, P = .001). Furthermore, SEEG was associated with 4.8% and SDE was associated with 15.5% morbidity (WMD = −10.6%, 95% CI = −11.6 to −9.6%, P = .001). SEEG was associated with 0.2% mortality and SDE was associated with 0.4% mortality (WMD = −0.2%, 95% CI = −0.3 to −0.1%, P = .001). Significance In this systematic review of SEEG and SDE invasive monitoring techniques, SEEG was associated with fewer surgical resections yet better seizure freedom outcomes in those undergoing resections. SEEG was also associated with lower mortality and morbidity than SDE. Clinical studies directly comparing these modalities are necessary to understand the relative rates of seizure freedom, morbidity, and mortality associated with these techniques.

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Section: Resultsmentioning

confidence: 99%

Section: Epileptic Surgery and Outcomesmentioning

confidence: 99%

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

et al. 2019

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“…5,6,[8][9][10][11][12][13][14] Most centers either do not report or do not perform postexplant CTs routinely. Typically, complications due to electrode placement in SEEG are described as "major" or "symptomatic" without mention or discussion of any other types of bleeding seen on imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Although our total postimplant hemorrhage rate was 19.1%, the rate of symptomatic hemorrhage was 2.2%, similar to that reported in other SEEG studies as well as a recent systematic review. 5,6,[8][9][10][11][12][13][14] Most centers either do not report or do not perform postexplant CTs routinely. When including patients who had a symptomatic hemorrhage postexplant, our symptomatic hemorrhage rate was 3.5%.…”

Section: Discussionmentioning

confidence: 99%

Risk analysis of hemorrhage in stereo‐electroencephalography procedures

et al. 2019

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Summary Objective To examine the true incidence of hemorrhage related to stereo‐electroencephalography (SEEG) procedures. To analyze risk factors associated with the presence of different types of hemorrhage in SEEG procedures. Methods This was a retrospective, single‐center observational study examining every SEEG implantation performed at our center from 2009 to 2017. This consisted of 549 consecutive SEEG implantations using a variety of stereotactic and imaging techniques. A hemorrhage grading system was applied by a blinded neuroradiologist to every postimplant and postexplant computed tomography (CT) scan. Hemorrhages were classified as asymptomatic or symptomatic based on neurologic deficit seen on examination. Statistical analysis included multivariate regression using relevant preoperative variables to predict the presence of hemorrhage. Results One hundred five implantations (19.1%) had any type of hemorrhage seen on postimplant CT. Of these, 93 (16.9%) were asymptomatic and 12 (2.2%) were symptomatic, with 3 implantations (0.6%) resulting in either a permanent deficit (2, 0.4%) or death (1, 0.2%). Male sex, increased number of electrodes, and increasing age were associated with increased risk of postimplant hemorrhage on multivariate analysis. Increasing score in the grading system was related to a statistically significant increase in the likelihood of a symptomatic hemorrhage. Significance Detailed examination of every postimplant CT reveals that the total hemorrhage rate appears higher than previously reported. Most of these hemorrhages are small and asymptomatic. Our grading system may be useful to risk stratify these hemorrhages and awaits prospective validation.

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“…In seven patients, an Engel class I outcome was achieved, along with neuropsychological and behavioural improvement. Taussig et al 27 used SEEG in 65 paediatric patients, 78% of whom underwent surgical resection. The mean clinical follow-up was 24 months, with 67% of children achieving an Engel class I outcome.…”

Section: Stereotactic Eegmentioning

confidence: 99%

Recent developments in the surgical management of paediatric epilepsy

2017

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Among the 1% of children affected by epilepsy, failure of pharmacological therapy and early age of seizure onset can lead to worse long-term cognitive outcomes, mental health disorders and impaired functional status. Surgical management often improves functional and cognitive outcomes in children with medically refractory epilepsy, especially when seizure remission is achieved. However, surgery remains underused in children with drug-resistant epilepsy, creating a large treatment gap. Several recent innovations have led to considerable improvement in surgical technique, including the recent development of minimally invasive diagnostic and therapeutic techniques such as stereotactic EEG, transcranial magnetic stimulation, MRI-guided laser ablation, as well as novel paradigms of neurostimulation. This article discusses the current landscape of surgical innovation in the management of paediatric epilepsy, leading to a paradigm shift towards minimally invasive therapy and closing the treatment gap in children suffering from drug-resistant seizures.

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Stereo‐electroencephalography (SEEG) in 65 children: an effective and safe diagnostic method for pre‐surgical diagnosis, independent of age

Cited by 74 publications

References 24 publications

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

Risk analysis of hemorrhage in stereo‐electroencephalography procedures

Recent developments in the surgical management of paediatric epilepsy

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