Stereoelectroencephalography in the very young: Case report

Katz, Jordan; Armstrong, Caren; Kvint, Svetlana; Kennedy, Benjamin C.

doi:10.1016/j.ebr.2022.100552

Cited by 1 publication

(2 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…16 These reports were part of larger series including all ages, the individual patients were not discussed in detail, and complications, accuracy, and outcomes were not individually reported. Thus, outside of our prior case report (case 2 in the present report), 19 our literature search revealed little to no guidance about whether this technique can or should be performed in this age group.…”

Section: Discussionmentioning

confidence: 57%

“…6,[12][13][14] Only 3 patients under the age of 2 have been reported to undergo SEEG at other institutions, and individual outcomes in these patients are not available. [15][16][17][18][19] In a recent national survey, only 31% of pediatric epilepsy surgeons in the US had performed SEEG in children under age 3, and ABBREVIATIONS CSF = cerebrospinal fluid; ICH = intracranial hemorrhage; SDG = subdural grid-based; SEEG = stereoelectroencephalography; TPE = target point error.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Stereoelectroencephalography before 2 years of age

Rahman

Tomlinson

Katz

et al. 2022

Neurosurgical Focus

Self Cite

View full text Add to dashboard Cite

OBJECTIVE Stereoelectroencephalography (SEEG) is a widely used technique for localizing seizure onset zones prior to resection. However, its use has traditionally been avoided in children under 2 years of age because of concerns regarding pin fixation in the immature skull, intraoperative and postoperative electrode bolt security, and stereotactic registration accuracy. In this retrospective study, the authors describe their experience using SEEG in patients younger than 2 years of age, with a focus on the procedure’s safety, feasibility, and accuracy as well as surgical outcomes. METHODS A retrospective review of children under 2 years of age who had undergone SEEG while at Children’s Hospital of Philadelphia between November 2017 and July 2021 was performed. Data on clinical characteristics, surgical procedure, imaging results, electrode accuracy measurements, and postoperative outcomes were examined. RESULTS Five patients younger than 2 years of age underwent SEEG during the study period (median age 20 months, range 17–23 months). The mean age at seizure onset was 9 months. Developmental delay was present in all patients, and epilepsy-associated genetic diagnoses included tuberous sclerosis (n = 1), KAT6B (n = 1), and NPRL3 (n = 1). Cortical lesions included tubers from tuberous sclerosis (n = 1), mesial temporal sclerosis (n = 1), and cortical dysplasia (n = 3). The mean number of placed electrodes was 11 (range 6–20 electrodes). Bilateral electrodes were placed in 1 patient. Seizure onset zones were identified in all cases. There were no SEEG-related complications, including skull fracture, electrode misplacement, hemorrhage, infection, cerebrospinal fluid leakage, electrode pullout, neurological deficit, or death. The mean target point error for all electrodes was 1.0 mm. All patients proceeded to resective surgery, with a mean follow-up of 21 months (range 8–53 months). All patients attained a favorable epilepsy outcome, including Engel class IA (n = 2), IC (n = 1), ID (n = 1), and IIA (n = 1). CONCLUSIONS SEEG can be safely, accurately, and effectively utilized in children under age 2 with good postoperative outcomes using standard SEEG equipment. With minimal modification, this procedure is feasible in those with immature skulls and guides the epilepsy team’s decision-making for early and optimal treatment of refractory epilepsy through effective localization of seizure onset zones.

show abstract

Section: Discussionmentioning

confidence: 57%