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

Katz, Joel S.; Abel, Taylor J.

doi:10.1007/s13311-018-00703-2

Cited by 65 publications

(72 citation statements)

References 68 publications

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“…The increment of ExT resections/disconnections and invasive recordings that we observed even in children younger than 7 years can be considered an index of an increasing complexity of surgical procedures. 28 Nevertheless, the observations that ExT procedures mainly increased in older children, tumors remained more common than other pathologies, and the proportion of surgeries in patients with unrevealing MRI did not significantly change over time when analyzing the total group of centers might reflect persistent uncertainties affecting early referral of complex cases for pediatric epilepsy surgery. 2,[5][6][7]11 In addition, the decrease in the proportion of TL surgeries and the increase in the proportion of unrevealing MRI cases and hemispheric and multilobar surgeries over time were significant at newer centers only.…”

Section: Proportion Of Mcdsmentioning

confidence: 96%

Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country‐, center‐, and age‐specific variation

et al. 2019

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Objective To profile European trends in pediatric epilepsy surgery (<16 years of age) between 2008 and 2015. Methods We collected information on volumes and types of surgery, pathology, and seizure outcome from 20 recognized epilepsy surgery reference centers in 10 European countries. Results We analyzed retrospective aggregate data on 1859 operations. The proportion of surgeries significantly increased over time (P < .0001). Engel class I outcome was achieved in 69.3% of children, with no significant improvement between 2008 and 2015. The proportion of histopathological findings consistent with glial scars significantly increased between the ages of 7 and 16 years (P for trend = .0033), whereas that of the remaining pathologies did not vary across ages. A significant increase in unilobar extratemporal surgeries (P for trend = .0047) and a significant decrease in unilobar temporal surgeries (P for trend = .0030) were observed between 2008 and 2015. Conversely, the proportion of multilobar surgeries and unrevealing magnetic resonance imaging cases remained unchanged. Invasive investigations significantly increased, especially stereo‐electroencephalography. We found different trends comparing centers starting their activity in the 1990s to those whose programs were developed in the past decade. Multivariate analysis revealed a significant variability of the proportion of the different pathologies and surgical approaches across countries, centers, and age groups between 2008 and 2015. Significance Between 2008 and 2015, we observed a significant increase in the volume of pediatric epilepsy surgeries, stability in the proportion of Engel class I outcomes, and a modest increment in complexity of the procedures.

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Section: Proportion Of Mcdsmentioning

confidence: 96%

Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country‐, center‐, and age‐specific variation

et al. 2019

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“…SEEG utilizes intracerebral electrodes stereotactically inserted to assess the anatomoelectroclinical correlation of seizures . This method was first developed by Talairach and Bancaud at Hospital Sainte Anne in Paris in the late 1950s to introduce three‐dimensional recording of deep sulci and gray matter .…”

Section: Introductionmentioning

confidence: 99%

“…Complications of SDE consist mostly of infection and hemorrhages, with pooled prevalences from meta‐analyses ranging from 2.3% to 4.3% from insertion and postimplantation monitoring . Although adverse effects of SEEG and SDE have been studied in previous literature, no head‐to‐head comparisons of large series have been made to date …”

Section: Introductionmentioning

confidence: 99%

“…SEEG utilizes intracerebral electrodes stereotactically inserted to assess the anatomoelectroclinical correlation of seizures. 5,6 This method was first developed by Talairach and Bancaud at Hospital Sainte Anne in Paris in the late 1950s to introduce three-dimensional recording of deep sulci and gray matter. 7,8 SEEG is sometimes preferred if there is a need to sample deep cortex such as insular cortex, cingulate gyrus, or medial temporal structures, or if bilateral explorations are necessary.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 Although adverse effects of SEEG and SDE have been studied in previous literature, no head-to-head comparisons of large series have been made to date. 6 The relative risks and benefits of SEEG and SDE have not been directly examined in a large series. Thus, this systematic review aims to pool a large series of data on patients diagnosed with drug-resistant epilepsy to evaluate the relative efficacy of SEEG and SDE with regard to rates of resective epilepsy surgery and ultimate seizure freedom.…”

Section: Introductionmentioning

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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Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery

Jehi

Morita-Sherman

Love

et al. 2021

Annals of Neurology

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Objective: The aim was to compare the outcomes of subdural electrode (SDE) implantations versus stereotactic electroencephalography (SEEG), the 2 predominant methods of intracranial electroencephalography (iEEG) performed in difficult-to-localize drug-resistant focal epilepsy. Methods: The Surgical Therapies Commission of the International League Against Epilepsy created an international registry of iEEG patients implanted between 2005 and 2019 with ≥1 year of follow-up. We used propensity score matching to control exposure selection bias and generate comparable cohorts. Study endpoints were: (1) likelihood of resection after iEEG; (2) seizure freedom at last follow-up; and (3) complications (composite of postoperative infection, symptomatic intracranial hemorrhage, or permanent neurological deficit).Results: Ten study sites from 7 countries and 3 continents contributed 2,012 patients, including 1,468 (73%) eligible for analysis (526 SDE and 942 SEEG), of whom 988 (67%) underwent subsequent resection. Propensity score matching improved covariate balance between exposure groups for all analyses. Propensity-matched patients who underwent SDE had higher odds of subsequent resective surgery (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.05, 1.84) and higher odds of complications (OR = 2.24, 95% CI 1.34, 3.74; unadjusted: 9.6% after SDE vs 3.3% after SEEG). Odds of seizure freedom in propensity-matched resected patients were 1.66 times higher (95% CI 1.21, 2.26) for SEEG compared with SDE (unadjusted: 55% seizure free after SEEG-guided resections vs 41% after SDE). Interpretation: In comparison to SEEG, SDE evaluations are more likely to lead to brain surgery in patients with drugresistant epilepsy but have more surgical complications and lower probability of seizure freedom. This comparativeeffectiveness study provides the highest feasible evidence level to guide decisions on iEEG.

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

Cited by 65 publications

References 68 publications

Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country‐, center‐, and age‐specific variation

Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country‐, center‐, and age‐specific variation

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

Comparative Effectiveness of Stereotactic Electroencephalography Versus Subdural Grids in Epilepsy Surgery

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